The Assembly met at 13:30 with the Llywydd (Elin Jones) in the Chair.

I call Members to order.

1. Questions to the Cabinet Secretary for Education

The first item on our agenda this afternoon is questions to the Cabinet Secretary for Education, and the first question is from Jenny Rathbone.

Pupils’ Well-being

Jenny Rathbone AC: 1. What plans does the Cabinet Secretary have to ensure that pupils’ wellbeing gets as much attention as attainment in our secondary schools? OAQ52785

Kirsty Williams AC: Thank you, Jenny. Positive mental health and well-being are key factors in a pupil’s performance and attainment in school. That is why we have committed to a step change in the support that is available in this regard and established a ministerial task and finish group to consider a whole-school approach that will ensure that well-being becomes part of every school’s ethos.

Jenny Rathbone AC: Well, I think that's a very welcome development. We know that Estyn has been evaluating standards progress and well-being of learners living in poverty in all its inspections since 2010, but that obviously hasn't been sufficient to ensure that all of our learners are achieving to the best of their ability. We know that there are multiple reasons why pupils may be struggling, with issues at home or issues at school, including bullying or unidentified special needs. This can, and does, impact on their behaviour in the classroom and therefore sometimes I appreciate that exclusions are necessary to enforce the rules of the school and ensure that all pupils are safe and in a position to learn.
Looking at the statistics, unlike in England, I think it's good to know that there doesn't appear to be any disproportionate exclusion of black pupils. However, we have to recognise that permanent exclusions have a devastating impact on the long-term prospects for any young person in that situation, as their employability is obviously going to be in doubt and the cost to public services, in terms of being on benefits and most of them ending up either in mental health services or in the criminal justice system, is obviously huge.
So, with this new working party and its focus in mind, how can you ensure that the most disadvantaged children are getting the well-being support they need so that all can achieve to the best of their ability? And, are you satisfied that the pupil deprivation grant is a sufficiently robust tool for tackling this?

Kirsty Williams AC: Thank you, Jenny. We know that children with higher levels of emotional, behavioural, social and school well-being on average have high levels of academic achievement and are more engaged in school, both concurrently and in latter years, and that's why we've been very clear in our national mission to have put the well-being of learners, including all aspects of a learner's life, as of paramount importance to schools.
You referred to the work that Estyn has previously done in this regard. In this year's remit letter to Estyn I have asked them to do a refreshed piece of work looking at how schools are establishing a whole-school approach to well-being, establishing what needs to be done to make that happen successfully and so that we can share that good practice.
The pupil development grant is a highly important tool in addressing the specific learning needs of children from our poorer backgrounds. Only last week, on a visit to north Wales, talking to teachers from Christchurch County Primary School in the Rhyl area—a school that has free school meals levels in excess of 60 per cent—they said that the funding available to them by the pupil development grant was invaluable in ensuring they could address the whole-child needs of the pupils in their school.

Paul Davies AC: The Cabinet Secretary will be aware of the hugely successful Hafod project following her recent visit to Ysgol y Preseli in my constituency. As she will know, the Hafod project aims to improve the well-being of pupils and promotes positive attitudes to learning, which I feel is vital to assist pupils to progress and reach their full potential. Given the great interest the Cabinet Secretary expressed in this project, can she give us an update on the progress now being made by the Government in looking to support this successful project?

Kirsty Williams AC: Thank you, Paul, and thank you for the invitation and the opportunity that I had to visit Ysgol y Preseli with you to hear first hand from the staff and the students at the school that participate in that scheme. Since that visit to Ysgol y Preseli, I have been very fortunate indeed to visit the PEAR Institute at Harvard University, which is the partner with Ysgol y Preseli in delivering that programme, and officials have been instructed to contact the PEAR Institute to look at how we can develop the project further, with the potential of seeing if other schools would be able to participate in that programme, and I will write to the Member with an update on that work. The impact that the programme has in Ysgol y Preseli is very interesting indeed and is clearly making a difference to pupils' levels of well-being, which in turn reflects on their academic achievements within the school. And there is certainly something, I believe, in that programme that we can learn from.

Female School Pupils’ Welfare

Jane Hutt AC: 2. What action will the Welsh Government take to support female school pupils’ welfare? OAQ52781

Kirsty Williams AC: Thank you, Jane. The welfare and safety of all learners is of paramount importance. Our national mission makes clear our objectives to deliver strong and inclusive schools committed to excellence, equity and well-being for all.

Jane Hutt AC: Thank you, Cabinet Secretary. In the Member debate on period poverty in May, we heard how some schoolgirls from low-income families were missing school when they had their periods because of the challenge of managing away from home without adequate sanitary protection. I welcome the Welsh Government's announcement of £700,000 of capital funding to improve facilities and equipment in schools, and it was particularly encouraging to note that this funding will be used in primary schools as well as secondary schools. This is an acknowledgement of research that shows that more girls are starting their periods at a younger age and that some primary schools can lack the facilities they need. Can we have an update on the impact of this funding, and what are the expectations in terms of the sustainability of this funding in the future?

Kirsty Williams AC: Thank you, Jane. As you rightly identified, the money that was made available via my colleague the leader of the house was split into capital and revenue streams. The £700,000 capital has been used to invest in school toilet facilities, to ensure that they are designed and have the facilities available to enable girls to manage their periods with dignity. The revenue aspect of the grant has been distributed to local authorities, because the Government believes that they are in the best place to decide how best to distribute products. And that is being done through either community hubs, food banks or a number of projects that exist in local areas. We have asked local authorities to provide information to Welsh Government on how the grants have been spent, and early indications demonstrate that there have been a variety of interesting ways in which that money has been utilised.
With regard to product in schools, some local authorities have made products available in school, but all schools should have made it very clear to pupils where they can obtain free products within their school environment should they be needed. I understand that the leader of the house has not made a decision yet as to funding in the future, but, clearly, any funding decisions will be influenced by the feedback from the utilisation of the funding to date.

Leanne Wood AC: A report by children's charity Plan International UK shows that a third of girls have been sexually harassed in public when wearing school uniform, and the opinion poll, which canvassed 1,000 teenagers and young women aged 14 to 21 across the UK found that two thirds of girls had experienced unwanted sexual attention or sexual physical contact in public. Chwarae Teg has found that sexual harassment can put girls off their chosen career path. Now, I'm concerned about all these findings, if not hugely surprised given the climate that we find ourselves in. But what I want to know from you is what support is in place to provide support for girls who have experienced sexual harassment and assault. This might be a good opportunity for you to look at the provision of school counselling services, which the Children's Society have found to be patchy. And can you also tell me what work schools are doing to educate young people that sexual harassment is not acceptable?

Kirsty Williams AC: Presiding Officer, could I thank Leanne Wood for raising this really important topic? I too was appalled, but not surprised, by the findings of that Plan International UK survey. I want to ensure that education settings in Wales are a place of safety, a place where all girls can be confident and undertake their studies and activities without this threat. And I say that as the Cabinet Secretary and the mother of three girls. Clearly, there is more work to be done. On the issue of supporting girls, clearly there is a need to ensure that our curriculum, via our current personal and social education lessons, and in our new curriculum of our new relationship and sexuality education programme, explores these issues from the very youngest age for both girls and boys, because, of course, boys are absolutely crucial in ensuring that girls do not have to endure this kind of behaviour. In our new curriculum, our new relationship and sexuality education will begin at statutory schooling age. So, from our very youngest pupils, we will begin to address these issues so that we can see a culture change in how girls and women are having to live their lives.
With regard to current support services, local authorities have a responsibility, indeed a duty, to provide counselling services for all children in year 7 through high school and in year 6. Individual local authorities have chosen to do that in different ways. For instance, in my own local authority, there is a heavy reliance on online counselling facilities and they have enjoyed very positive feedback from young people. But there is a duty on all local authorities to provide those service.
We are also, of course, about to go out to consultation on the school uniform itself to look to introduce new statutory guidelines around school uniform, which will hopefully address perhaps some concerns that girls have about what they're able to wear, both in terms of school uniform and PE kit, and will hopefully address some of these issues.

Questions Without Notice from Party Spokespeople

Questions now from the party spokespeople. TheUKIP spokesperson, Michelle Brown.

Michelle Brown AC: Thank you, Presiding Officer. Cabinet Secretary, some time ago, I asked you if you saw any advantages for further and higher education establishments in leaving the EU and you replied that you didn't. An article by the BBC earlier this month highlighted that our colleges are discovering that there are opportunities for further and higher education for those who take the trouble to look for them. Does that article earlier this month, where the BBC reported that the head of Cardiff college said that Brexit is leading to a huge £3 million boost from Chinese students, show that you were wrong or is it the college principal who is wrong?

Kirsty Williams AC: I'm very pleased that Cardiff and Vale College are looking to explore new opportunities. International students are very important to both our FE and HE institutions, and I would like to send a very clear message to students across the world that, in coming to study in Wales, they can be assured of a very positive experience. If only I could convince the Home Office not to include their numbers in our immigration figures, perhaps we could have even more of them.

Michelle Brown AC: Thank you for the answer, Cabinet Secretary. The vice-principal went on to say:
'Our partnership with China has become very strong over the last two years, potentially helped by Brexit.'
Your party—by which I mean the Liberal Democrat party that you represent, rather than the Labour Party that you've ended up serving—wants to ignore the votes of the majority of Welsh voters and stay in the EU, as do your fellow members of the Cabinet. If you get your way and secure a fake Brexit, what steps will you take to make up the multimillion-pound shortfall from the dividend that colleges and universities can expect from Brexit?

Kirsty Williams AC: I have to say, Presiding Officer, that the Member, and perhaps her colleagues around her—but I can never tell whether there is consensus amongst the members of the UKIP group—are the only people who I know, in the FE and the HE sectors, who are approaching Brexit without trepidation. I would urge her to listen to Universities Wales and the FE sector about the very real challenges that are going to face further and higher education as a result of Brexit: the fact that there will be restrictions on the number of students who can come and study here; the fact that there is already a huge amount of disquiet from European members of faculty who are potentially already making decisions to leave Welsh HE and go and work elsewhere; the threat to Horizon 2020 and the threat to the availability of Welsh students to participate in Erasmus+. All of those issues present a very real threat to our FE and HE sectors.

Michelle Brown AC: Thank you for the list of red herrings, Cabinet Secretary. I'll crack on to the practical aspect of this. I'd like to know what you're actually doing to help universities and colleges market themselves to the wider and more lucrative international student base. For example, have you asked vice-chancellors in FE colleges what practical support you can give them? For instance, sponsoring and organising their attendance at educational fairs and paying for the release of staff for them to do that in international markets such as China and Malaysia, which could be very lucrative for us, or how lending them endorsement from Welsh Government could give their marketing campaigns more impact, so that more students can be attracted to Wales. Can you please explain to me what practical measures you're currently taking to actually market our universities and colleges outside the EU, which is, actually, where the majority of the market is—not the EU?

Kirsty Williams AC: Clearly, the Member did not particularly listen when I was recently at the Children, Young People and Education Committee giving evidence in this regard. If she had listened, she would be aware of the £2 million-plus investment that has been given to Global Wales via the European transition fund to assist them in marketing HE institutions abroad. In September, I hosted, alongside the vice-chancellor of Swansea University, a 'Study in Wales' event at the British consulate in New York. We continue to develop our relationships with the HE sector in Vietnam, and one of the pro vice-chancellors from University of Wales Trinity Saint David will be in Vietnam shortly, again developing systems-to-systems working.
But, let me be absolutely clear, while all this is very welcome, if the Member listens to Universities Wales, she will be aware of their huge concerns regarding the impact of Brexit. If she cared to listen to the student voice, she would be aware that those concerns expressed by the universities and the concerns expressed by me and this Government, are the concerns expressed by the student voice as well. I wonder why there is such consensus in this regard if these fears are unfounded.

Plaid Cymru spokesperson, Llyr Gruffydd.

Llyr Gruffydd AC: Thank you very much, Llywydd. Minister, teachers in schools are to receive a pay rise of 3.5 per cent, or up to 3.5 per cent, but we will have a situation then where teachers teaching sixth-form pupils in schools will receive a pay rise, whilst those teaching sixth-form students in further education colleges won’t receive a corresponding pay rise. Now, I’m not going to ask you to intervene in the current negotiations, but, as a point of principle, do you agree that we need to ensure fair play in terms of salary to teachers in FE colleges, as compared to those in schools?

Eluned Morgan AC: Well, may I say thank you very much, Llyr, for the question? You will be aware that teachers' salaries are currently decided by the Westminster Government, and we'll receive a consequential in order to pay for that, but that isn't happening as far as FE is concerned.
As regards the current situation, we’re monitoring the situation regarding the negotiations between the unions and ColegauCymru, and, let’s be clear, they are responsible for determining the salaries. But, in principle, I believe that it would make sense that a person teaching physics to the sixth form in a school deserves the same kind of salary as those teaching in sixth-form colleges.

Llyr Gruffydd AC: Thank you for that clarity and thank you for accepting the principle, because that is an important message the sector wants to hear. According to ColegauCymru, it seems that £10 million will be required to pay for salary increases for FE staff in order to provide the same pay rise for them.
Now, being aware of the funding situation in the sector as it currently exists, then it’s likely that the Welsh Government would need to meet that cost, or at least some of that cost. So, can I ask, as you know that there is a dispute at the moment, as you know that the likelihood is that the Government will be asked to contribute to that additional cost should it arise, and also, as you know that the Government’s budget here is in the process of being completed, what negotiations have you had with the Cabinet Secretary for Finance to argue for further support to ensure fair salaries for those in that sector?

Eluned Morgan AC: Well, until we’re clear about what the outcome of the discussions will be, it’s very difficult for us to decide what should be included in the budget. But, may I make it quite clear to you that we are aware of the position? The finance Secretary is aware that this might be a matter that we will need to look at. So, I do think that we need to underscore the fact, of course, that we are endeavouring to deal with these issues while we’re still trying to deal with austerity, because, of course, that has created a problem. So, it is a difficult question and it’s a difficult issue for us to take these decisions, but you must be quite clear that we are aware of the situation, as is the finance Secretary.

Llyr Gruffydd AC: Thank you very much. Now, you said recently, and I’m sure that you may have anticipated that someone might raise this—but you said that there may be a need for more emphasis on lifelong learning, and that that isn’t a priority for the Welsh Government. Can you be clear with us: isn’t that your fault, because you are the Minister responsible for this area within this Government?

Eluned Morgan AC: Thank you very much. Obviously, that was discussed at another forum, and I don’t believe that this is the place to discuss the future priorities of the Labour Party. But may I make it quite clear that it is austerity that has led to the cuts that have taken place to date, but that the current Government is completely committed to ensuring that we continue to invest in basic skills and in teaching English as a second language, and also to ensuring that we teach people digital skills? So, that commitment still stands from the Government.

Conservative spokesperson, Suzy Davies.

Suzy Davies AC: Diolch yn fawr, Llywydd. Yesterday was Restart a Heart Day. I'm sure you've been anticipating this question. The health Secretary's out-of-hospital cardiac arrest plan can only go so far, and as far as I can tell from speaking to the relevant charities across Wales, there is still resistance among your officials to include emergency life-saving skills, not just cardiopulmonary resuscitation, as a mandatory part of the new Donaldson curriculum. Now, I appreciate that the Donaldson approach is about not being over-prescriptive, but there are exceptions to this already. What evidence do I need to give you to make the teaching of mandatory life-saving skills one of those exceptions?

Kirsty Williams AC: Thank you, Suzy. I had indeed anticipated, at some stage, you would ask this question, because of your times campaigning in this regard. As you quite rightly identify, 'Successful Futures' has challenged us to rethink our approach to the curriculum, and it makes very clear that a high degree of prescription and detail at a national level inhibits, and I would quote from Donaldson's report,
'flow and progression in children and young people’s learning'.
As such, we need to ensure that the curriculum does not provide a comprehensive, detailed list of everything that has to be taught, and there is real danger in doing that. However, these are important skills that children should have access to learning. So, you'll be aware that one of the areas of learning and experience, as outlined by Donaldson, is health and well-being, and that work is currently being taken forward by our network of pioneer schools. Officials are also working with pioneer schools and representatives from the British Heart Foundation, the British Red Cross and St John Ambulance to consider safety and the health of others in the new curriculum. And they're working together to consider how that curriculum can support and enable schools to incorporate life-saving skills as the learner needs.

Suzy Davies AC: Thank you. I was anticipating your answer as well, as it happens. I expect we'll be back here before the Donaldson curriculum is finalised, because I think there is space—this is not the same as, 'Can I bring falconry on to the curriculum?', this is about life-saving skills. And there's a demand for it to be mandatory on the curriculum, as far as I can tell, so perhaps we'll return to it.
In the meantime, I just want to go back to the questions you were answering earlier on on female school pupils' welfare. The Children's Commissioner for Wales has found that gender bullying, of course, is still a problem in our schools, and that there's a recognition now that autistic spectrum disorder amongst girls is probably recognised less frequently than its actual prevalence, partly, of course, because girls manage to learn behaviour that disguises the experiences they're actually having. Now, I personally think Paul Davies's Bill will direct both attention and resources towards this, but I'd be grateful to know what you're doing at the moment to raise awareness with staff and pupils about how girls with autistic spectrum disorder conditions may present in schools, and how to support them if they're being bullied, and perhaps on those occasions when they might be the perpetrator. Thank you.

Kirsty Williams AC: Thank you, Suzy. Let me be clear: there is hardly a day goes past when I am not asked to put something in the curriculum, so, believe me, there is a lot of demand for very many subjects to be a statutory element of the curriculum. I don't know if I've ever had falconry, but I have had other things of that ilk that have been suggested to me should be mandatory for all schoolchildren.
On the issue of bullying, I'm sure that many Members may have seen newspaper coverage and internet coverage of some cases just this week of a young girl. I want to make it absolutely clear: there is no place for bullying of any kind of any of our students in our schools. I expect our schools, as I said to Leanne Wood, to be safe spaces for our children and young people. We are in the process this very term of updating and refreshing our anti-bullying guidance to all schools to make it a much more useable document than perhaps we have had in the past and that will be published later on.
The Member also makes a very good point about the identification and support of children with additional learning needs—

Suzy Davies AC: No, no.

Kirsty Williams AC: —of all kinds.

Suzy Davies AC: But not ALN.

Kirsty Williams AC: ALNand children with neurodifferences who may present in school with different sets of behaviours that perhaps could be a point that a bully decides to focus on. So, our new professional learning development, both in initial teacher education and continuing professional development for staff already in the school—it partly does address the ALN, because if we can get it right for ALN children we'll be getting it right for all of our children. The benefits of greater understanding, empathy and how we can deal with difference in our classroom—regardless of the source of that difference—actually help all of our children. I'm very pleased to say the initial feedback from Estyn, who are looking at our new ALN preparations and transformation programme, have been very positive about the developments to date.

Suzy Davies AC: I'm grateful for that answer, actually. I'm pleased to hear that the work's being done on the bullying guidance there, which I hope will be as broad as possible and include bullying for lesbian, gay, bisexual and transgender—and a whole range of other factors that we've spoken about here before.
I was grateful to the Minister for confirming my understanding that the pay rise for teachers—the Barnettisation consequential of that, which you mentioned would go to teachers in recent questions here—probably doesn't include lecturers. Can I ask you then—the finance Secretary, a couple of weeks ago in reply to my question on the draft budget, said that he was putting £15 million into your budget to go, quote, direct to schools. Now, is that new money or is it part of the £100 million he's already promised you and what is it to be spent on?

Kirsty Williams AC: First of all, can I just correct—? It's a technical thing, but it does need to be corrected.

Suzy Davies AC: That's fine.

Kirsty Williams AC: There is not a Barnett consequential to pay for teachers' pay rises. In England, that money has to come out of the Department for Education. These are resources that we have persuaded the Westminster Government it was their duty to provide for us, so it's not a Barnett consequential. Although that seems like a minor thing, actually, it is, in the big scheme of things, quite an important distinction to make. I can also be absolutely clear that every single penny of that money will be distributed, via the revenue support grant, to local authorities to be used for teachers' pay. None of it will be retained in the centre. The £15 million is additional to my budget; that's why you will see a plus sign next to the education main expenditure group in the finance Minister's paperwork. We will be distributing that money via individual local authorities. It will primarily be for the purpose of professional development, and I hope to make a statement to the Chamber at a later date to give full details of our new professional development package for existing staff in our schools.

Teachers' Pay and Conditions

Joyce Watson AC: 3. Will the Cabinet Secretary make a statement on the devolution of powers over teachers' pay and conditions? OAQ52771

Mark Reckless AC: 5. Will the Cabinet Secretary make a statement on the outlook for teachers’ pay following the devolution of powers in this area? OAQ52764

Kirsty Williams AC: Thank you very much, Joyce. Presiding Officer, I understand that you've given permission for question 3 and question 5 to be grouped. So, these powers were devolved on 30 September. The first teachers’ pay and conditions to be set by Welsh Ministers will apply from 1 September 2019. These will be informed by a mechanism including in-depth discussion with a stakeholder partnership forum and detailed consideration by a new independent review body.

Joyce Watson AC: I thank you for that answer and I look forward to those consultations coming back. What do you think, Cabinet Secretary, might be the main benefits to teachers and pupils, going forward, now that we do have those powers?

Kirsty Williams AC: For me, this is the last piece in the education jigsaw and I'm very glad indeed that we've been able to come to this position where those powers are now formally devolved. For too long, we have seen the teachers' pay and conditions regime respond to an agenda from a different Government to support a different education system. This allows us to tailor-make our teachers' pay and conditions to mirror the values that underpin our education system, and I hope it will give us the opportunity to make Wales the place to be an education professional.

Mark Reckless AC: Sorry, Llywydd. Am I saying:
'Will the Cabinet Secretary make a statement on the outlook for teachers’ pay following the devolution of powers'?
Or have we been there?

You need to ask your supplementary.

Mark Reckless AC: Yes. What, Cabinet Secretary, do you see as the key opportunities from the devolution of pay specifically? And how significantly do you expect the regime for pay to diverge from that in England, particularly in the early years?

Kirsty Williams AC: Thank you, Mr Reckless. I've been very clear that, following the devolution of these powers, teachers in Wales will not be disadvantaged in comparison to their colleagues in England. Because of the ongoing nature of austerity, the opportunities for pay are perhaps at this point limited, but I think there are some very exciting opportunities around the issue of conditions. Of course you will be aware of the publication last month of the report authored by Professor Mick Waters, which gives me some interesting pointers on how we can use these new powers. It's a very interesting piece of work, and I shall be responding formally to that report.

David Melding AC: Cabinet Secretary, I've served as a school governor since 1992, and I've always been privileged to work with the most outstanding senior management teams. I do notice in the independent review that has given you advice on how these powers may be used that the way headteachers are employed could change radically, so that they're employed on a regional and national basis. Now, I wonder how that might work out. Is the idea behind that to bring up the schools that are achieving at a standard that we think needs to improve, to bring them up to the best, and that you might be putting in new senior management teams to really get them moving?

Kirsty Williams AC: Well, first of all, can I thank David for his own personal commitment to the national mission by serving as a governor? As I said to Mark Reckless, there are some really innovative suggestions in the report authored by Professor Mick Waters and others. What we do know is that good leadership is key to a successful institution, and he has interesting things to say about how we can deploy our very best leaders in the system to raise standards. Of course, in other countries, high-performing education countries, the human resource management of the teaching workforce is dictated from the centre and, indeed, not just headteachers but individual teachers are assigned schools to work in by the Government. Now, of course, I wouldn't want to set all the hares running this afternoon by suggesting that that's where we're heading, but there are some interesting proposals in Mick Waters's work. Of course, we will be looking to respond to those formally, and any response that we make as a Government will be in collaboration with the sector itself, including both the National Association of Head Teachers, which I will be meeting on Friday, as well as the Association of School and College Leaders and other people with an interest in this area.

Growing the Welsh Economy

Mohammad Asghar (Oscar) AC: 4. What action is the Welsh Government taking to ensure that workers have the skills required by businesses to grow the Welsh economy? OAQ52759

Eluned Morgan AC: Diolch, Mohammad. The Welsh Government is supporting the development of a skilled workforce, including delivering 100,000 apprenticeships this Assembly term. Our flexible skills programme is supporting businesses across Wales to upskill their workforce, and we're also working with the regional skills partnerships to ensure that skills provision in each region responds to business need.

Mohammad Asghar (Oscar) AC: Thank you very much for this precise answer, but the fact is that you will be aware that a recent Estyn report found that most providers of higher level apprenticeships do not manage them well and that many courses are outdated. They went on to say that, as a result, many providers did not reflect current practice and the needs of employers in Wales. Welsh Water sends its staff to college in England to fulfil training needs, while other large companies have been forced to develop their own apprenticeships because their training needs are not offered elsewhere in this country. What action is the Cabinet Secretary or your good self taking to address these concerns to ensure that Welsh workers have the skills required to allow businesses to grow and thrive, please?

Eluned Morgan AC: Thank you. You're absolutely right: it was the Welsh Government who commissioned that report by Estyn, of course, because we were concerned that, perhaps, in relation to the higher apprenticeship framework, we weren't getting the kinds of results that we'd hoped for. So, that's why we commissioned the report. We're obviously taking the recommendations in that report very seriously. We are working with Qualifications Wales to make sure that they understand there's a need to drive up standards, and a lot of this is about making sure that we communicate and we work with the appropriate sectors to make sure that we are responding to the needs of what businesses want, so that the curriculum needs to really address the issues that need to work in a concrete way, in a practical way, in the workplace.

Siân Gwenllian AC: According to recent research by Chwarae Teg, young women still favour sectors that are traditionally dominated by women, despite the need for more women in areas such as the STEM subjects, for example. One claim made in the report is that careers advice services don’t provide the necessary support for young girls. I do know that a number of individuals are doing excellent work, but is the Government confident that careers advice services are challenging stereotypes sufficiently and providing information about all sorts of careers and sectors?

Eluned Morgan AC: Thank you for that. We are all concerned about the lack of women in STEM subjects. We need to increase that and that is why we have a specific programme in order to ensure that we try to get more girls to study these subjects. Many more European funding programmes have received support recently in order to push for girls to go into these subjects. I think that the careers sector is extremely aware of the situation. We do have Have a Go days, where they encourage girls to have a go at subjects that aren’t traditionally female roles. So, this is an exceptionally important issue for the Government, and what we don’t wish to see is that girls and women are encouraged to go into sectors where they are trapped in careers that don’t attract high salaries. So, we want to increase the number of girls going into STEM subjects, and I think that the careers sector is very aware of that.

Caroline Jones AC: Cabinet Secretary, Minister, the Welsh economy will be transformed in the coming decades as digital technologies become more prominent. Businesses will have to adapt as data becomes the most valuable commodity. In order to help our economy adapt, we must ensure that our young people have the necessary skills. Cabinet Secretary, what is your Government doing to ensure future generations have the coding skills needed for our future digital economy?

Eluned Morgan AC: So, we have a very specific and clear programme that the Cabinet Secretary is leading in relation to digital skills in schools. We are also very aware, in terms of the skills in the sector, that we need to move in this area. That's why we have commissioned Professor Brown to look at automation, the impact that automation and digitalisation will have on our economy and how we should best, as the Welsh Government, respond to that. So, we are on this case. We are very aware that there could be, potentially, tens of thousands of jobs that will be changed, that will be eliminated as a result of the digital age, but we need to also see this as an opportunity, because of course there will be thousands of new jobs that will be created and we need to make sure we have the skills in the workforce to make sure that those are appropriately provided for. We're on this case; we're awaiting, with anticipation, that report from Professor Brown.

Voting Age

Mick Antoniw AC: 6. Will the Cabinet Secretary make a statement on the role that educational institutions will play if the voting age in Wales is lowered to 16? OAQ52757

Kirsty Williams AC: Thank you. Pupils currently study politics and current affairs within the Welsh baccalaureate and through personal and social education in the current curriculum. Our new curriculum has four purposes, including supporting young people to develop as ethical, informed citizens of Wales and the world, who can exercise their democratic responsibilities and rights.

Mick Antoniw AC: Cabinet Secretary, thank you for that answer, although I don't think it actually goes far enough. I did a consultation in two schools in my constituency—in Y Pant and Bryn Celynnog—and it resulted in this submission, which went in, in fact, to the Welsh Government's consultation on electoral reform in local government, but is directly relevant to the legislation that's being proposed now in terms of reducing the voting age. What was very clear was that 16-year-olds are very much of the view that they should have votes at 16, provided there is clear education that is sufficient to enable them to understand the issue. What was also very clear is that they felt it should start at the age of 14, but it should go much further than the way in which the baccalaureate—. In fact, there was a considerable degree of dissatisfaction with the adequacy of the level that was currently included.
If we are going to empower students at the age of 16 to be able to vote, then we actually have to have a clear system of political education within our schools that allows access to politicians, to organisations. For example, co-operatism and mutualism isn't taught within schools and hasn't really appeared in any part, yet it is a significant part of social policy, as are many other aspects of social history and so on. It does seem to me that we actually have to have a root-and-branch review of the consequences of giving votes to students at 16 and the actual need to ensure that the education system is adequate on all the issues that they will have to decide. With that responsibility really requires the education and the empowerment of those 16-year-olds.

Kirsty Williams AC: Thank you very much, Mick. Well, I've got a 14-year-old at home and she is delighted at the prospect of being able to cast a vote at the next set of elections. But you're absolutely right—[Interruption.] I don't think so. [Laughter.] You're absolutely right that we need to ensure that our children are given the information that they need to be able to exercise these new opportunities.
We are learning the lessons of what happened in Scotland when Scottish 16-year-olds had the right to vote in their referendum. There was a great deal of work between the Electoral Commission in that nation, and schools, and Government. We are in regular contact with the Electoral Commission here to understand the lessons that can be learned. That also means the production of suitable materials for use in our schools, and I hope to be meeting alongside my Cabinet colleague the Cabinet Secretary for local government and the Presiding Officer shortly, to discuss the implications of the vote that was held here recently and how we need to work together to ensure that our young people have the information that they need.

Andrew RT Davies AC: There'll be a differing view from some Members in the Chamber whether it should be 18 or 16, but there's a clear direction of travel that shows a vote at 16 will be coming into play in Wales. But at every opportunity—and this is where I agree with the Member for Pontypridd—young people have indicated that they do feel that they require more education to understand the role that they will play when it comes to casting their vote.
Could the Cabinet Secretary give a little bit more information as to how she sees that educational element of the McAllister review, for example, and other informative opinion pieces being rolled out in schools? Because we're only now just over two and a half years away from the next Assembly election. And if it is to be the franchise at 16, then surely the department has an idea of how this role in education is going to be unfolded in Welsh schools so that people can be informed, like young people are asking.

Kirsty Williams AC: Well, Andrew, I don't disagree with you. As I said, we are using the experience of Scotland to guide us in this particular area. So, we are working with the Electoral Commission, who have a duty to provide public information on all elections. The Electoral Commission is developing a toolkit to help people register because that's an important part of the process, that young people understand the need to register to use their right to vote. So, we're in regular contact with them, and we will be discussing a public information campaign to register young voters, as well as looking at the evidence of Scotland, where Education Scotland actually produced materials for schools to be used in schools ahead of the referendum, to help teachers guide their students.
As I said, under the current curriculum, there is provision within the PSE element to be able to provide young people with these opportunities. I'm sure there are Members across the Chamber, of all political colours, who regularly attend visits in schools to talk to young people, as well as using the opportunity, like I did last week, to visit the Llangynidr Brownies to talk to young people about the history—in this case, the history of women voting—and why it's important to be a voter and why that matters. And I'm sure all Members—I think we all have a personal responsibility, as each of our parties has a political responsibility also, to be able to afford young people these opportunities. But I will write to the Member with more details of the work that is going to be undertaken in line with the Electoral Commission.FootnoteLink

Information further to Plenary

Student Finance Wales

Jayne Bryant AC: 7. Will the Cabinet Secretary make a statement on Student Finance Wales's customer satisfaction rates? OAQ52779

Kirsty Williams AC: The Student Finance Wales satisfaction rate for the year to date was at 86 per cent, as of 1 October. I remain committed to ensuring that Student Finance Wales provides a service of the highest quality.

Jayne Bryant AC: Thank you, Cabinet Secretary. I've received a number of complaints from constituents about their experience of making Student Finance Wales applications. Correspondence with the Student Loans Company, which provides the Student Finance Wales service, has not provided some of my constituents with the outcomes and explanations they sought. A repeated concern is the observation that staff had not had sufficient training to equip them to answer specific questions, and that more senior management aren't available on hand to assist. This can lead to delays in processing applications, causing great distress to constituents, who have clear and obvious deadlines for university. Can the Cabinet Secretary outline what discussions have taken place with the Student Loans Company to ensure that Student Finance Wales provides the best possible service?

Kirsty Williams AC: Thank you, Jayne. I am very sorry to learn of the difficulties some of your constituents have experienced whilst dealing with the Student Loans Company. I met, the week before last, with the new chief executive of the Student Loans Company at their offices in Llandudno Junction to discuss with her and other senior members of staff my expectations of what we want for Welsh students, and we continue to discuss with them how services can be improved.
We are aware of some difficulties the Student Loans Company has had in terms of recruitment and retention of staff at Llandudno Junction, and I'm very pleased that we have been able to reach an agreement with the Treasury and the Student Loans Company that the Student Loans Company will become a real living wage employer for all of those staff, which I hope will begin to address some of those issues of recruitment and retention. Indeed, a number of new members of staff have been inducted this month, but there are still some vacancies in the office, and clearly that can lead to some difficulties. And we continue to discuss, as I said, with the SLC, what steps they can take to improve the service available to Welsh students.

Janet Finch-Saunders AC: I would like to endorse exactly the same sort of comments as Jayne Bryant AM, because I know that my team of staff and I have felt deeply frustrated at the silences at the other end when we're dealing on behalf of someone who is desperate, and the length of time that they've been taking to even respond to correspondence has, frankly, not been acceptable. But when talking about student finance, I am being more and more approached by a number of students who are becoming increasingly concerned about their own levels of debt. Research from the Higher Education Policy Institute shows that graduates from the poorest households will see their debts rise by 20 per cent, from £25,000 to £30,000, and graduates from households with an annual income of £50,000 will see their debts rise by around 40 per cent.
For the past seven years, Bethan Jenkins Assembly Member, our colleague, has raised in this Chamber, so many times, about financial inclusion and financial education through our schools, our colleges and our universities. I've supported her in those calls, and I know that the Government were supposed to be taking some firm steps to look at how we can bring this kind of awareness and profile raising of how to manage your own finances. Cabinet Secretary, how is the Welsh Government acting on all the debates that we've had previously, where there was a mention that this would be taken forward?

Kirsty Williams AC: Can I say, Presiding Officer, I took the time to sit with the call handlers at Llandudno Junction to watch how they operate and the service that they deliver? And can I say, I was hugely impressed by the dedication of those staff and their commitment to getting it right? So, I certainly, when I was there, didn't witness any silences at the ends of lines, and I'm surprised that the Member feels this way about many, I suspect, of her constituents who work in that office.
With regard to the issue of student debt,let's be absolutely clear what students from the poorest households in Wales get: they get a non-repayable grant in excess of £9,000 per year to study, and let's be absolutely clear, Janet Finch-Saunders, those same students, if they lived across the border in England, they would receive nothing. Not a single penny.
With regard to financial inclusion, the Member does make serious points, and she will be aware that, as we develop our new curriculum, issues around financial education and financial inclusion are very important, and indeed, again, I have taken the time to look to see how this is being actually delivered in our schools, and saw a fantastic lesson delivered at Olchfa secondary school in Swansea that was at the very heart of, yes, teaching maths, but also teaching students about tax, how they could work out their tax bills, and, crucially, what their tax was used for—and in this case, it's supporting poor students.

Jack Sargeant AC: Cabinet Secretary, I've received quite a number of correspondence about studying, student finance and Student Finance Wales. Most people's experience is rather good. Now, I appreciate that you can't comment on specific cases, but I have had a constituent recently contact me about the difficulties in securing support for students studying overseas. Could you just, Cabinet Secretary, outline what support the Welsh Government can offer Welsh students studying in the United States, for example?

Kirsty Williams AC: Thank you very much, Jack. As you are aware, currently the full package of student support is only available for students who study in the United Kingdom, either full-time, part-time, or at undergraduate or postgraduate level. However, I recognise the benefits some students have from pursuing a period of study abroad. That's why I'm very keen that students should continue to have access to the Erasmus͏+ programme.
With regard to the recommendations in the Diamond review that said the Welsh Government should look at what kind of support can be made available for overseas students, I hope to be able to make an announcement to this Chamber this term about a pilot in that regard, but I have to be very clear that that will be for a period of study in a foreign country, not for the entirety of a course.

Finally, question 8, David Melding.

New Technology and Innovation

David Melding AC: 8. How does the Welsh Government's education programme develop skills in new technology and innovation? OAQ52783

Kirsty Williams AC: Thank you, David. 'Education in Wales: Our national mission' sets out our approach to ensure our young people are digitally competent and evolve into enterprising, creative and critical thinkers. These skills will feature strongly in our new curriculum and are already embedded in everything a learner does in school through our digital competence framework.

David Melding AC: Cabinet Secretary, you may have seen a recent report that said the Welsh technology industry is growing faster than any other area except London. During 2016, the number of digital companies launching in Wales grew from 3,000 to 3,275, or a growth of 9.1 per cent, and Cardiff and Swansea are now the leaders in this technological drive. It is very, very important that this is reflected in the curriculum so that our young people can take advantage of these opportunities and indeed create them, and should you need a special adviser, can I recommend my eight-year-old nephew, who advises me very well in this area?

Kirsty Williams AC: I suspect all Members in this Chamber have the equivalent of your eight-year-old nephew who assists them in these matters. I know I certainly do. The Member is absolutely right to draw our attention to the importance of ensuring that our children are well equipped to take advantage of these economic opportunities that are becoming increasingly available. That's why we have invested £1.3 million in the teaching of coding in our schools. That's why the digital competence framework is the first part of our new curriculum to be made available to our educational establishments, and I'm delighted that we have been able to work with the Higher Education Council for Wales to establish the Institute of Coding, which will allow Cardiff and Swansea universities to become even more active members of that very important consortium.
We are also working collaboratively with the higher education sector to broaden the computer science skills we have at all levels in our communities, so that whether you're a schoolchild, whether you're a student at FE or HE, or indeed the adult learners that Eluned Morgan talked about earlier, access to digital skills continues to be a priority.

Thank you, Cabinet Secretary.

2. Questions to the Cabinet Secretary for Health and Social Services

The next item is questions to the Cabinet Secretary for Health and Social Services, and the first question is from Mandy Jones.

Betsi Cadwaladr University Local Health Board

Mandy Jones AC: 1. What is the Welsh Government's plan for bringing Betsi Cadwaladr University Health Board out of special measures? OAQ52790

Vaughan Gething AC: Thank you. I've set out clear expectations for the health board to meet to be considered for de-escalation in the special measures improvement framework. I will make an oral statement on Betsi Cadwaladr University Local Health Board’s progress on 6 November.

Mandy Jones AC: Thank you for that answer. Cabinet Secretary, the north Wales health board has been in special measures since June 2015. At that time, we were told that the action taken reflected serious and outstanding concerns about the leadership, governance and progress of the health board. Cabinet Secretary, I'm grateful for the update you provided around the three-year anniversary of special measures, but what I struggle to assess is the trajectory of improvement and when the health board will be delivering the quality of services that my constituents deserve. Cabinet Secretary, if the health board is getting there, as you state, when will it have reached its final destination?

Vaughan Gething AC: It'sa question that Members will continue to ask until we see real and lasting improvementin the delivery of the areas that are in special measures. We've seen progress on maternity. We have not seen adequate progress on mental health. We've some progress on out-of-hours. We've seen some progress on leadership.
Mental health has always been the most challenging area of activity, and so the health board has made progress on having a strategy, but it can't simply be a case, for the convenience of politicians, certainly for me, to set an artificial time frame. That's why the special measures framework has the chief exec of NHS Wales, together with Healthcare Inspectorate Wales, our regulator, together with the Wales Audit Office, to make sure this is not a process that is driven by what is convenient for me or anybody else in the Government, but a real and honest assessment of the progress that a health board has made. So, the improvement plan I set out is the plan for them to adhere to, to get out of special measures. There will be an honest and upfront report on their progress, both on 6 November and in the future. Members and the public should take the reassurance that there is a genuine independent oversight on the progress that is or is not being made.

Darren Millar AC: You said you didn't want to set out a time frame for improvements, and yet I remember, when the previous health secretary actually put this health board into special measures, he announced there were 100-day plans to turn the situation around. Well, it's now been 1,228 days.
Many of the indicators in terms of performance in that health board are going backwards. It's a record-breaking health board now, because it has the record-breaking worst-ever accident and emergency department performance in two of its hospitals just in the last month, and we know that its financial situation isn't resolved, the mental health problems in that health board still aren't resolved, and there are still questions around the capacity of the leadership and the governance in the health board to turn the situation around.
You say that you're setting out your expectations, but you are absolutely failing to deliver on those expectations—the improvements that you have promised and which your predecessor had promised that would be made in this health board. I don't think leaving the situation completely open-ended is good enough. People want some direct accountability in our health board system. They don't have that at the moment—you don't accept responsibility, and the health board fails to make any decisions because it's in special measures and it says that you're the one making all of the decisions.
So, do you accept that the accountability arrangements in the national health service are not good enough, and that this is a prime example of why they're not good enough? And what are you going to do to make health boards more directly accountable to the public?

Vaughan Gething AC: Well, as Members will know from our regular outings in the Chamber, in statements, in debates and, indeed, in questions that I receive every three weeks, there is regular and direct accountability. I answer questions and I'm held to account on a regular basis. As far as Betsi Cadwaladr is concerned, there is a new improvement framework, with improvements to be made, and I expect to be held to account for them. I have never sought to try and deny the fact that I have responsibility for the health service here in Wales—far from it.
The challenge about our framework for accountability is to have that honesty and objectivity within it, to actually measure the progress we're making, the additional support that we're providing, not just in people, but also in terms of the additional resource we've made, the additional resource we've made available from this June, for example—nearly an extra £7 million for providing additional personnel to deliver improvement. And I will be upfront about where the health board has made progress, just as I'll be upfront about where the health board still has more to go. Members should, though, take some comfort from the fact that our staff within the health board are actually much more positive about working for the organisation than they were two years ago and four years ago. As the staff survey shows, there have been significant improvements in whether staff rate the health board as a good place to work, or they say they're proud to work for the health board, and whether they'd recommend treatment for a friend or relative. So, there is real progress being made, but, until we see the significant and sustained improvement in mental health services in particular, and progress to be made on financial discipline within the health board too, as well as headline elective performance, I will, of course, continue to face questions, just as the health board will themselves.

Llyr Gruffydd AC: One of the difficulties that the health board finds difficulty in tackling is in the transfer of care, and I don’t know if you can explain to me how we saw a situation that we saw in Chirk hospital recently, where it took 368 days to transfer one patient, according the community health council. Now, not only is that bad for the patient, but it’s also bad for the hospital and anyone else who needed use of that bed. So, when are we going to see health and community care services co-ordinated effectively in north Wales?

Vaughan Gething AC: Thank you for the question. We have actually seen significant progress made on reducing delayed transfers of care right across our health service, including within north Wales. I and the Minister look at the figures every single month and where there is a falling back between health boards we absolutely make sure that action is taken and questions are asked. So, there's no lack of oversight or interest from Ministers in this Government about the progress that we've made, or complacency. That progress will be continued. It's only partly about resources: much of it is about working relationships, and, since I came into the department as a then deputy Minister, I can say there has been a significant improvement in relationships between health and local government, and that has led to an improvement in performance as well.
In the individual case you mentioned, whilst I can't comment on the individual circumstances, I can broadly say that where a delay of that length has taken place it is almost always because there is a complex care package that is not available for that person. What I would be interested in, though, is if you'd write to me, and either I or the Minister will investigate and come back to you with the detail in that matter.

Orkambi

Andrew RT Davies AC: 2. Will the Cabinet Secretary provide an update on discussions the Welsh Government has had with Vertex Pharmaceuticals about the cystic fibrosis drug Orkambi? OAQ52768

Vaughan Gething AC: Thank you for the question. Neither I, nor my officials, have had any formal discussions with Vertex about Orkambi. I have, though, reminded Vertex that a medicine must be appraised and recommended by the National Institute for Health and Care Excellence or the All Wales Medicines Strategy Group before it can be routinely provided by NHS Wales. It is Vertex's responsibility to comply with the appraisal process, which they are both aware of and fully understand.

Andrew RT Davies AC: It is regrettable, Cabinet Secretary, that you haven't had direct conversations with them, although you do point out that you had some discussion about their responsibilities. In other parts of the United Kingdom, this drug is available for cystic fibrosis sufferers and, regrettably, it's not available here in Wales, as I understand it. Why has there been so little progress in making that drug available here in Wales? As I understand it, other health departments have come to arrangements with the pharmaceutical company to make it available. Will you commit to working with the pharmaceutical company to make this drug available here in Wales, because the benefits have been proven and are clear to cystic fibrosis sufferers? Sadly, cystic fibrosis is a condition that is lifelong— it's not something that comes to you as you progress through life—and, so, therefore, the better the treatment we can offer, the longer the life, and the quality of life is improved for the individual. So, I'm asking you: please will you commit, as the Minister and the department, to engage positively to make this drug available here in Wales?

Vaughan Gething AC: I must confess that I'm regularly frustrated at the manner in which the discussion around Orkambi has taken place. At the centre of all this, we should remember, are people, families, who want to have the best possible treatment available on our national health service. Every single company that manufactures a medicine available for the NHS understands the process they must go through, and that process is to make sure that medicines are safe and effective and that there is an appropriate value for that treatment. This treatment—Orkambi—is not readily available on the national health service in any other UK nation. That is simply not the case. It is potentially—. It is not available in other nations within the United Kingdom, nor is it available in Wales. It is available on individual patient funding requests, and it has been made available on a trial basis by the manufacturer on a limited basis for people in each of the different UK nations. So, it is simply wrong to suggest that NHS Wales has taken a different view. That is part of my frustration, because I accept that Members in every party have had correspondence from the company, and I believe I've had correspondence from Members in each and every party in this Chamber who have written to me about the issue. And I am frustrated about the lack of clarity in the process. Because I do not believe that Members are recounting matters—they have not been told, and accepted in good faith.
The benefits are not proven—that is one of our biggest problems in this area. Orkambi did not simply fail a NICE appraisal on cost grounds, but NICE, on the information available to it on clinical data provided by Vertex, put it onto the 'do not use'list. Now, that is highly unusual, and that is because of the state of the clinical data available at the time. I have said, more than once, directly in correspondence to Orkambi, and, indeed, when I got doorstepped above this place by the company and their representative, that they need to engage in the process that they understand. And that is part of my frustration. I do not believe that you are having the full story painted to you. In the Petitions Committee, when they considered this matter—[Interruption.] In the Petitions Committee, when this matter was raised, it was stated that, since the NICE appraisal, there are now 96 weeks of additional clinical data available. NICE and the All Wales Medicines Strategy Group cannot assess that information, because it has not been provided to them. Once that information is provided to NICE, then a decision will be made. But it is the company's responsibility, and nobody else's, to provide that data and information, because they have access to it and no appraisal body does. I'm more than happy to talk to Members outside here, but my frustration is that I do not believe that the full picture is being provided to you about the manner in which this drug is and is not available and responsibility for that.

Dawn Bowden AC: I too have had discussions with Vertex, and I've made representations to you about a particular constituent of mine, who I know is very concerned that her daughter, who's only about seven years old, can have access to this drug. But, in my discussions with Vertex, I've been, like you, hugely frustrated—they seem to understand what the process is, but, for whatever reason, are not engaging in the way that they know that they have to. But my question to you is: if those proper processes were followed by Vertex, and Orkambi was to meet all the tests of both NICE and the All Wales Medicines Strategy Group, would it then be eligible under the new treatment fund?

Vaughan Gething AC: Yes, and I think that's quite helpful, because, whilst I am frustrated that there hasn't been a meaningful engagement in the process, if they did, this is exactly what the new treatment fund is for. So, when new treatments become available that are NICE approved—so, they are proven to be effective and safe and cost-effective—there is often a challenge in getting those drugs in an equitable manner into our system. It is exactly what the new treatment fund is designed for, and I can say, yes, this would be eligible for support within the new treatment fund to make it available on a rapid and consistent basis. And, as we know, that means that, here in Wales, effective medication, with an evidence base behind it, is available more quickly here than in any other UK nation, and I am very proud of that.

Bethan Sayed AC: I think if it's the case that people are not informed, then that's why people are raising it here, so that they can get information from you as Cabinet Secretary, and I think that that would be something that we should be mindful of here. I understand, from speaking with Vertex, that there was some frustration in dealing with all-Wales medical procurement, which resulted in significant delays in this process. Perhaps it was an isolated incident—and I hope it was—but it's something that should be looked into in relation to this particular case. Could I ask you whether there are any plans to amend processes to permit the assessment of a portfolio of medicines, showing the flexibility needed for these types of medicines for rare diseases? Now, we've been here before with Kalydeco, and had a change of mind from the Minister at the time. A portfolio of types of medicines for rare diseases would be something that would be welcomed for you to look at, at least, and I'm sure not only Vertex would welcome that, but us as directly elected representatives also.

Vaughan Gething AC: I accept completely that Members in every party are acting in good faith in asking questions around this. I completely accept that. There has been engagement between our appraisal process on a number of occasions, which has not resulted in the additional clinical data being provided. The procurement question is interesting. But you get to that point once you have gone through the appraisal process. Because, if the manufacturer cannot demonstrate that the medicine on offer is effective and safe, then it doesn't really matter what the price is. If Vertex offered something for £1 a go—well, if you can't demonstrate that it's effective, then it isn't going to get through the gate. The challenge about procurement and a possible portfolio approach becomes interesting once the clinical data is available, and that would then potentially allow us to take a different and a broader view, in exactly the same way that a number of drug manufacturers already do; they call them 'patient access schemes'. So, yes, I am open and our system here in Wales—as indeed is every other UK nation—is open to a sensible conversation about cost once Vertex comply with the process that they, and every other drug manufacturer, understand and they make available that clinical data for a proper and independent appraisal.

Questions Without Notice from Party Spokespeople

Questions now by the party spokespeople, and Plaid Cymru spokesperson, Rhun ap Iorwerth.

Rhun ap Iorwerth AC: Diolch, Llywydd. I'm sure you'll be aware, Cabinet Secretary, of the decision of the highly respected Professor Siobhan McClelland—health economist, health manager; held senior positions on health boards—to leave Wales to seek better care for her husband, who has cancer. She's reported as saying:
'There is neither capacity nor capability in Welsh Government to be making really good health policy.'
Surely you have to agree that, coming from somebody as respected as Professor McClelland, that is about as damning an indictment as you could hear of your running of the Welsh NHS.

Vaughan Gething AC: I am, of course, sorry that Professor McClelland has cause—and, from the statement made by the health board, good cause—to complain about the care that her husband has received. I'm also sorry that she feels the need to change where they live. But I don't accept the system-wide criticism that she makes of the national health service here in Wales. I accept that her view is—. Of course, as with every patient, you understand your own individual experience. When I look at what the system-wide reviews have shown here in Wales—. Look at the Organisation for Economic Co-operation and Development review; that did not suggest that there was a system-wide problem, as described by Professor McClelland. If you look, indeed, at the more recent independent review that every party in this Chamber agreed to in the form of the parliamentary review, they did not agree with the criticisms that are now made by Professor McClelland. That independent parliamentary review process has led to the creation of 'A Healthier Wales'. That is the joint plan for health and social care, it includes system reform and improvement, and I'm committed to delivering that.

Rhun ap Iorwerth AC: Professor McClelland has looked at the NHS in Wales and how it's run probably more forensically than anybody else and one of her concerns is that your Government struggles to get health boards to do what you want them to do.
Now, in the most recent budget, your Government has chosen to add over £500 million extra to health and social care—on the face of it, good news; we all want to see investment in health and social care. But, with plenty of other areas of need and other departments, other public bodies, facing cuts, who could blame them for asking, 'Is this really investment or is it just a bail-out?' So, in light of Siobhan McClelland's concerns, are you in control of what happens to that £500 million or is it just going to disappear into a black hole of financial mismanagement?

Vaughan Gething AC: I think the Plaid Cymru spokesman should be careful in the manner in which he sets out his views. It almost sounds as if he's inviting the Government to cut the health budget. I think, actually, what we need to do is we need to deliver on our joint plan for improvement across health and social care. It has taken a significant—[Interruption.] It has taken a significant amount of work to get to having a joint plan with buy-in from health, local government, the third sector and housing. There will always be a need to look at financial efficiency and discipline within the service. If you look at that, then, actually, there has been real improvement over the last three years, and much more to do. The health service will never be completely perfect—there will always be room for error and improvement, as well as significant achievement. I am content with the fact that we understand there are real challenges, and we're not complacent about actually managing and meeting those.

Rhun ap Iorwerth AC: A rather glib response, I must say, in terms of me inviting a cut in health and social care budgets. My question is: are you in control of what happens to that increase, which I welcome, if it is an actual increase, if it is investment? Now, the danger, of course, is that it's a fire-fighting fund. We've seen it time and time again—£100 million here, £200 million there, in order to plug gaps. Where you have a fire-fighting fund, you have £500 million that won't address, for example, chronic underinvestment in primary care. It won't form part of creating long-term sustainability. So, let me invite you to spread this investment and make sure that this investment works. Yes, you say it's for social care as well as health, but, in looking at where in health to put that money, will you commit, if you're in control, to instructing the health boards to give, say, half to primary care so we can start at last to build a sustainable service?

Vaughan Gething AC: I'm committed to delivering 'A Healthier Wales', which is our joint plan that has a real focus on shifting our investment and activity into local healthcare. I've said before on a regular number of occasions that trying to have an artificial figure on the amount to go into one part of the system is not the right way to go about doing that. We've set out not just a transformation fund, but we've set out additional resource to go into that transformation fund as well. That is joint funding for health and social care to choose how to use together on joint priorities. We set up, for the first time, additional money directly from health to go into social care as well. That is a choice that I have made as a portfolio Minister because I recognise the need for the system to be properly funded across social care as well as health. So, I am keeping the promises I have made to health and local government on the way in which we will use resources to deliver the joint plan that they have all signed up to. That is exactly what I will not be blown away from doing because it is the right thing to do for our citizens becausethat will deliver better care, more integrated care and care that is generally closer to home.

The Conservative spokesperson, Angela Burns.

Angela Burns AC: Diolch, Llywydd. Cabinet Secretary, what specific action is the Welsh Government taking to reduce the prevalence of suicide in Wales?

Vaughan Gething AC: I've given evidence on suicide prevention to the committee that you're a member of and I'm looking forward to the report. You'll understand from the 'Talk to me 2' mid-point review that a range of measures have been looked at. For example, we took measures immediately following the evidence I gave to make sure that information that should be available on a wide basis—which we understood from, for example the Jacob Abraham Foundation was not—. So, we've taken immediate steps to try and make sure that help and support is available, both after the event and as well as things that we could and should do to try and prevent suicide in the first place.

Angela Burns AC: It cannot be right that one in three people who die by suicide have been in contact with mental health services in the year before their death. It goes beyond a doubt that we're failing to support some of our most vulnerable members of society and to provide effective support. Patients in Wales are consistently exposed to lengthy waits for assessment. Imagine the experience of approaching your GP and sharing some of your most intimate feelings only to be told to wait and endure this for a further 56 days before you have an initial assessment to determine whether you're ill enough to receive support. According to your latest statistics, this has been the reality for 528 people in Wales. This mentality of 'deteriorate before you can access treatment' would not take place in any other care pathway. So, why is that the case in mental health? We know that you rejected much of the children and young people committee's frankly damning report to see preventative mental health services improved. As you've mentioned, the health committee is currently undertaking a consultation on this issue. However, can you tell the Chamber today what exactly is your Government doing to strengthen access to preventative mental health services for people in Wales?

Vaughan Gething AC: I think you raise an interesting point about one in three people being in contact, but it also means that roughly two in three are not. So, there's a challenge about what we do if people are in contact with the health service as well as a broader societal challenge of actually persuading people to talk and to listen as well. On your point about what we are actually doing, there are two broad points I'd make. The first is that we're investing an additional £35 million into mental health and learning disability services in the next year, and a specific part of that will go into crisis care, because part of what you're talking about is what happens at a point of real crisis. We recognise that some parts of our system are better than others, so we will invest more in crisis care over the next year.
The second point is in respect of 'Mind over matter' and the more preventative end, of earlier intervention and prevention, not just the broad phrase of the missing middle, but in particular about children and young people. We're taking forward the commitments that we've made. Today was the first meeting of the joint task and finish group, chaired by myself and the Cabinet Secretary for Education, Kirsty Williams. You'll be aware that the Chair of the children and young people's committee is an observer on that, able to speak freely, as she certainly did during the committee today. That's to understand whether we're not just pointing in the right direction but whether we have the right people together to try and make a difference not just in a whole-school approach, but more broadly across our whole system as well. So, we are taking seriously the messages in the 'Mind over matter' report. We're committed to doing what we promised we would do, and I expect that we'll come back before the committee. As the Chair has indicated, she will give us the opportunity to appear before the committee in the spring to be able to say what we have done over the first six months and where we expect to be in the future as well. I recognise that Members do take this matter seriously, as they should.

Angela Burns AC: What I'd also like to try to drill down to is this issue of funding, because that's exactly what I wanted to determine from you today. You've just mentioned, and I believe that I quote you correctly, that you're going to put an additional £35 million into the mental health budget. To be frank, the budget is so opaque that it's very difficult to discern all of the lines—it's difficult to understand whether the ring fence for mental health still exists.
I believe that you said, in some written evidence to our committee, that you were going to be taking money for crisis and out-of-hours care into mental health out of the £100 million save-everything-in-the-NHS transformation fund—that's what was in the written evidence. Is this additional money of £35 million going to pay for that crisis and out-of-hours intervention uplift, or is that coming out of the transformation fund?
I believe that you're bringing a statement forward on the transformation fund, and I would like to see a list of where all of this money is going, because that £100 million has got so many people saying they're having money out of it that there's a real, real difficulty in discerning exactly where the funds are going. After all, it is our job to scrutinise the spend and to ensure the outcomes are achieved, so clarity on this matter would be most appreciated.

Vaughan Gething AC: I'm sure I'll have the opportunity during budget scrutiny to go into much more detail on those specific areas that we've got, but I'm happy to clarify the points you raise. Yes, you're correct: there'll be an extra £35 million—that is what I plan to invest in addition to what we already provide in mental health and learning disability services. The ring fence does still exist for mental health services.
There is some confusion about the term 'transformation fund', because there is a specific mental health transformation fund to do exactly what it says—to try to help to transform mental health services in different parts of the country.
The 'A Healthier Wales' transformation fund is separate; they're not the same amounts of money and not the same fund. I will be making a statement on the transformation fund to help deliver 'A Healthier Wales'—I think it's next week or the week after. I'll be able to confirm the process that organisations are going through and also how we're looking at the initial bids that have come in. So, I should be able to give you more detail then on what's already happened and what I expect to happen in future, but they are different funds. I hope that's helpful in clarifying, but I understand, given that there is a mental health transformation fund and the 'A Healthier Wales' transformation fund, why there may be some honest confusion about the issue.

The UKIP spokesperson, Neil Hamilton.

Neil Hamilton AC: Thank you, Llywydd. I was rather staggered to hear the health Secretary's response to Rhun ap Iorwerth's questions in today's session. Effectively, what the health Secretary did was to dismiss Professor McClelland's views as along the lines of not being able to see the wood for the trees or, perhaps, magnifying her own personal experience and universalising it unfairly to the health service in Wales.
Professor McClelland is one of our most distinguished health economics experts in the United Kingdom, but has also had a practical role in health service management as vice-chair of the Aneurin Bevan health board. She has been head of evidence for Macmillan Cancer Support and much else besides. I think she has drawn attention to a significant systemic problem in the health service in Wales, which she encapsulates in these few sentences. She says that:
'We've got a fundamental problem here with health boards, not in terms of geographical boundary, but in the autonomous way in which they act.... Health boards are neither strongly controlled by the Welsh Government nor are they accountable to the people. We have a void in Welsh Government where robust, rigorous, innovative health policy should be made.'
When somebody as distinguished as Professor McClelland makes points in that way, isn't it right that the health Secretary should listen?

Vaughan Gething AC: I have enjoyed working with Professor McClelland on a number of matters, in particular when she was the chair of the emergency ambulance services committee. I do value her contribution to the health service here in Wales.
But, her view on the nature of a systemic problem is not borne out and not supported by a range of other people. I've referred to the OECD, and I've also referred to the independent parliamentary review that looked at the system that we have and whether the system itself is fit for purpose. Their challenge to us was not to say, 'You need wholescale, system-wide reform because the system is broken'. Their challenge was how we actually use the levers that we have available to us to set a proper policy direction and deliver against it. There's a difference between delivering and whether the system itself is not fit for purpose. And the robust policy, the review and improvement of that, well, we've seen that with the parliamentary review and with 'A Healthier Wales', and if you look, for example, at the NHS Wales awards, you will see innovation taking place within our system. You will see evidence being used to generate new policy initiatives to generate new and better practice. That is exactly what we should have. That is what I expect for our system as we deliver on the joint plan for health and social care in Wales, and I am determined to do so.

Neil Hamilton AC: Of course, there are improvements in some parts of the health service in Wales, but in other respects we seem to be going backwards. So, in spite of all the money that is spent and the fact that half the health boards are either in special measures or in targeted intervention—in some cases, like Betsi Cadwaladr have been, for many years—progress is, at best, painfully slow. So, this, surely, gives us pause for thought as to whether the system itself is working or, indeed, can ever be made to work.
But I'd like to focus my next question in this respect particularly on Betsi Cadwaladr, just to pick up on answers to Mandy Jones at the start of questions today. One of the features of Betsi Cadwaladr is that more and more GP practices are being taken in-house and managed directly, most recently in Porthmadog two weeks ago—yet another practice taken directly under the wing of Betsi Cadwaladr. We've now got nearly 100,000 patients in north Wales who are under the direct management, ultimately, of the health board. What I would like to know is what performance reviews have been conducted on directly managed GP practices in Wales and what impacts it's thought that this management change has had upon patient care? When I met with GP representatives many, many months ago, they expressed some concern about this because, in particular, one of the problems that's developed is that individual patients no longer feel that they've got a personally accountable GP, because a lot of these practices are populated by locums. That leads to a growing lack of confidence not just in the hospital system, but also in the provision of primary care at the local level.

Vaughan Gething AC: Yes, there are a number of managed practices across our system. As an overall percentage, it is still very small. However, I recognise there is a change in the structure of general practice that is taking place. We will see fewer small practices of single or double-handed practitioners in the future, because our ambitions for the delivery of general practice, as set out in 'A Healthier Wales' and as we were encouraged to do from the parliamentary review, are to be able to deliver services together in a more integrated way and to be able to deliver a wider range of services. We are likely to see larger practices that are fewer in number. We're likely to see more general practitioners employed by other general practitioners as partners, much as you do see now currently in the law where most solicitors are employed by other solicitors.
The challenge is: do we still have good value for money? Do we still provide high-quality patient care? And in every managed practice and in all of the surveys that come back, the public are still happy with the service they get, and so there isn't an impact on patient care that you can see. We would, though, expect to see a higher cost because they're having to employ locums at a point in time to make sure the service continues, and that is the price that we will pay to make sure that general practice survives whilst we change it deliberately to make sure we have a better structure to deliver better care with more services in the future.

Neil Hamilton AC: Certainly, as far as north-west Wales is concerned, part of my region, Blaenau Ffestiniog and now in Porthmadog as well, we have a situation where things are actually getting worse, because patients do not feel that they have a personal relationship with an individual doctor, because they can't develop that sufficiently with a locum by definition, because they're not necessarily going to be there permanently.
There is another problem that this brings about as well, because when Betsi Cadwaladr takes a practice in-house, it withdraws the My Health Online internet tool that allows patients to make online GP appointments, and that makes it more inconvenient for patients as well. So, why is it that one of the features of directly managed practices is the withdrawal of useful technology that is vital to improve healthcare? Surely, this is not absolutely necessary. As Betsi Cadwaladr is still in special measures, perhaps the heath Secretary could enquire of the health board whether they can reverse this retrogressive policy.

Vaughan Gething AC: I'll be happy to look into the matter and write to the Member and copy in other Assembly Members as soon as possible.

Self-harm Prevention

Jayne Bryant AC: 3. Will the Cabinet Secretary provide an update on the Welsh Government’s self-harm prevention strategy? OAQ52792

Vaughan Gething AC: Thank you for the question. Our 'Talk to me 2' suicide and self-harm prevention strategy identifies groups of people who are especially vulnerable and puts forward actions to address the factors that can contribute to suicide and self-harm. The midpoint review of 'Talk to me 2' reported good progress towards many of the actions within the strategy.

Jayne Bryant AC: Thank you, Cabinet Secretary. Recent analysis by the Children's Society found that a quarter of 14-year-old girls and nearly one in 10 boys in the UK had self-harmed in a year. Sadly, the levels of understanding of the reasons behind these figures are poor. The 'Mind over matter' report conducted by the children and young people committee shed an important light on this issue. Their report found that the number of young people admitted to A&E departments for self-harm had increased by 41 per cent in the past three years. Only Aneurin Bevan university health board records how many people go to follow-up support in the days after being discharged from hospital for self-harm, a period when access to appropriate support is critical. Can the Cabinet Secretary outline whether other health boards are aware of this initiative, and what more can the Welsh Government do to improve access to support following discharge?

Vaughan Gething AC: Thank you for the question. As I've said earlier, we are taking seriously and taking forward our commitments made in response to the 'Mind over matter' report, with the first meeting of the jointly chaired ministerial task and finish group taking place earlier today. That was a constructive and positive meeting, so I'm looking forward to reporting on further progress in due course about what we are doing there.
However, our current 'Together for Mental Health' delivery plan set out our expectation that health boards will monitor the provision of support following hospital discharge; that is also set out in the 'Talk to me 2' delivery plan. I think what I should do is again to return to the Member to ask for proper reassurance from other health boards—they are actually taking that seriously and doing so. But more than that, in terms of how we assess and understand how it's being done, we are already looking to improve the data that we collect through the development of what's being called a mental health core data set—to understand that we're collecting the same information, in the same way, in the same place, to allow us to understand the improvement that's being made and the relative progress in different parts of the country. That goes alongside the implementation of the Welsh clinical care information system across Wales, to help improve monitoring of progress and action. That—I think helpfully for Members—is not just a matter for the national health service and clinicians, but it does involve the third sector too in engaging on what we should collect and how we should then present it and actually provide it to the public.

Mohammad Asghar (Oscar) AC: Cabinet Secretary, half of all mental illnesses begin by the age of 14. To mark World Mental Health Day last week, the Prime Minister announced a series of measures on children and young people's mental health. These included recruiting new mental health support teams who will work with schools to ensure young people with mental health issues get the help they need. Given that more than 3,000 people have signed a petition set up by a Gwent mental health group calling for young people to be given more of a say in mental health services, Cabinet Secretary, what measures will you take to ensure children and young people with mental ill health get the help and support they need in our country? Thank you.

Vaughan Gething AC: Thank you for the question. I note the Prime Minister's recent commitments and, as I said before, I welcome that the current Prime Minister and the previous Prime Minister have been prepared to talk openly about the importance of mental health services. The challenge has always been whether they've been able to match their words with resources and action on the ground. Don't take my word for it, ask practitioners and groups in England, and they'll say that the rhetoric hasn't matched reality. Our challenge here is not just to say that we're not as bad as England but to actually say, 'What can we do to further improve?' That is exactly what we are seeking to do in taking forward the task and finish group in response to the 'Mind over matter' report. I can confirm that it won't just be that there is a focus on children and young people in how we take that work forward, but actually that we will directly involve children and young people in informing our work. Part of that will be evidence the committee has already heard, information we already collect, but also direct, face-to-faceengagement with children and young people in different parts of Wales as we look to try and understand how we improve that earlier intervention and support.

Health Services in South Wales Central

David Melding AC: 4. Will the Cabinet Secretary outline the Welsh Government's priorities for health services in South Wales Central? OAQ52782

Vaughan Gething AC: Thank you. My priority for health services in the South Wales Central area, as with the rest of Wales, is to ensure that people have equity of access to safe, sustainable, high-quality and integrated health and care to meet their needs.

David Melding AC: Cabinet Secretary, Cardiff and Vale University Local Health Board has worked with partners in social care, the Welsh ambulance service and the voluntary sector to develop a winter plan to manage the increased demand on services, both at the University Hospital of Wales and at Llandough. The proposal includes an extra 32 beds for winter pressures and a further 12 beds as well if they are necessary. I also welcome that the network of community falls clinics within Cardiff will be accessible for individuals who are at a lower risk of falls who would benefit from an assessment to reduce their risk of falling in the future. Now, it remains to be seen if this planned and co-ordinated approach does deliver the type of strength we want in the system to respond to the winter pressures, but at least they are co-ordinating with the other key stakeholders. This ought to be the measure of what we should be seeingfor the future, not only in South Wales Central but in all parts of Wales.

Vaughan Gething AC: I'm happy to give the Member the assurance that a similar approach is taken by each health board, together with its partners in the Welsh ambulance service, their common partners, together with local government and the third sector, and, crucially, now drawing in colleagues in housing as well to understand how there is a proper plan ahead of winter. The challenge and the test always is how our joint services actually cope with the additional demand that we understand will come into the health and care system throughout the winter months and what more we can do successfully to keep people out of hospital who don't need to be there, but to make sure they're properly supported within their own homes. I will, of course, have more to say on these matters and planning for winter in the coming weeks and months as I continue to make statements and answer questions, but I'm very pleased the Member has taken the time to understand and engage with the winter planning process here in Cardiff and Vale.

Vikki Howells AC: Cabinet Secretary, as you will know, there has been significant work between Cwm Taf Local Health Board and Rhondda Cynon Taf council to develop a new integrated primary care facility in Mountain Ash. Now, this planned £6.5 million healthcare facility would replace outdated services in the town and adopt a holistic approach by bringing services together. Whilst recognising the work that has already been done to drive this project forward, what kind of benefits do you think the community will gain from this model, and how will the Welsh Government best support its delivery?

Vaughan Gething AC: Thank you for the question. I recognise this is a subject that you raised with me very early on after your election, together with the leader of the council, about the need to improve the facilities, and actually that is one of the first benefits to be seen. There will be fit-for-purpose, up-to-date modern facilities to replace what currently exists, and we sometimes understate the importance of the physical environment in a person's experience of care and where they're likely to access care in the first place. There then is that point about better access, because then we can draw together more services in the same place and, in particular, draw health and local government services together to make it easier for people to get to the right service in the right place. That, as we know in other parts of the country, has led to an improvement in the relationships between all of those different professionals. They're able to talk to each other and to understand, if it isn't a health problem that somebody is coming to you with, there is someone—if it's in the same building, it's even better—to understand how you help that person to actually find support for their problem. But that experience and those better services are part of the plan that we'd expect to see. That's why we're investing together money with the local authority on delivering these new facilities. It'll also be important for staff there as well, because we do know, in other parts of your constituency, for example, the different way that those practices are now working with each other has led to a better job by professionals who are more likely to stay.
And the final thing I'll say on this, Llywydd, is that the development between the health board and local authorities has not just helped in terms of the provision of new facilities; as you'll be aware from the NHS Wales Awards, the big prize on the night went to the Stay Well@home service—the partnership between health and local government to deliver improved care to keep people in their own homes for longer and out of hospital quicker. And there are real markers there within the Cwm Taf area for what the rest of the service needs to do.

Pre-exposure Prophylaxis and HIV Prevention

Dai Lloyd AC: 5. Will the Cabinet Secretary make a statement on pre-exposure prophylaxis and HIV prevention? OAQ52753

Vaughan Gething AC: Thank you for the question. Wales has seen a sustained decrease in new HIV cases. Since I announced the three-year PrEP study, which began in July 2017, 559 people have started on PrEP, and no-one in this cohort has contracted HIV.

Dai Lloyd AC: Thank you very much indeed for that answer, and further to your oral statement on this issue of 2 October and moving forward, obviously, generic PrEP drugs are cheaper than the current branded ones in issue. Would you agree that if there are any savings to be made from any such future switch to generic PrEP drugs, such savings would be well-used in actively promoting PrEP to groups who are not accessing it in the numbers we might expect at the moment?

Vaughan Gething AC: You make a completely fair point that once a branded, new medicine is available, there will come a period of time when generic ones are available, and it's work we've actually done across the whole service on making sure that generic products are used in preference wherever possible, because it doesn't remove the value, it improves the value, and it doesn't in any way diminish the efficacy of those drugs.
You make an interesting point about what happens if you see a reduction in a product that is particularly aimed at one area of the service and whether the savings for generic medicine should be retained in that service. What I would say is that I think that we want to make sure we provide equitable access to the best quality treatment, and I would be reticent about taking an approach that might be replicated in other parts of the service that mean we can't mean move funds around where we need to have them, but it would not lessen the importance of making sure we have an effective sexual health service so that we continue on the trajectory of trying to make sure that we meet the World Health Organization's ambition that we become HIV-free at the nearest possible point in the future.

Nick Ramsay AC: Can I concur with Dai Lloyd's comments and also welcome the news that the trials appear to have been successful? It seems a long time since those diagnosed with HIV, back when the condition first became known about back in the 1980s, didn't really have any hope. So, the fact that we are now not just having treatment drugs but preventative drugs like this must be welcomed.
From my understanding of the PrEP treatment, it's not just a case of it being taken sporadically, but it has to be taken consistently, and I think with regular medical check-ups every three months to make sure that the effectiveness is being maintained. So, can you tell us, as well as those who have been treated successfully and taken the drugs, what are you doing not only to raise awareness about this type of treatment for those for whom it's suitable, but also to make sure that HIV sufferers who are taking it realise the importance of maintaining that medication so that it's as effective as possible?

Vaughan Gething AC: Well, look, for those people who have started to take PrEP, we're really encouraged about the fact that no-one who was in that cohort has got HIV since starting. That's really important. But, as I said in my oral statement, we've been looking to get to people with the highest risk, and, so, we found other sexually transmitted infections within that group. That shows we're actually getting to the right sort of people. We've also found people who have had undiagnosed HIV, and they then have been supported in actually receiving appropriate treatment, and that's what we do need to do to make sure people are engaged in services that are built around them, that understand the needs they have to properly support them and people around them to make sure they live the best life possible, because I, too, remember when HIV and AIDS were made widely known—and I was a child—I remember the adverts on tv, and the fear and the stigma that that created. And, actually, to have a message that if you seek support and treatment, then you can live a good life and you can still have a proper life to live, it does not mean that your life is over—the stigma and the fear are still there. So, that is still a job of work for us to do, and I'm genuinely proud that here in Wales we've taken a progressive approach.
I've seen news in your area of the world, with the Argus, this week, printing an article actually talking about the situation in England, where they still have charities wanting a more reputable process than fundraising to provide PrEP to other people. I'm really pleased that I was able to take a decision here in Wales for full nation coverage on an equitable basis, driven by need, and need alone.

Access to Independent Advocacy and Support in North Wales

Darren Millar AC: 6. What action is the Welsh Government taking to ensure access to independent advocacy and support for those with poor mental health in north Wales? OAQ52788

Vaughan Gething AC: We recognise the vital role of independent advocacy in providing person-centred mental health support. The Assembly legislated for independent advocacy in our Mental Health (Wales) Measure 2010. We will increase our investment in mental health services again next year to continue to improve the support that is available.

Darren Millar AC: I know, to be fair, Cabinet Secretary, that you do value independent advocacy for people with mental health—. But I am a little bit concerned about some of the restructuring that's going on with mental health advocacy in my own constituency at the moment. You will be aware that there's an organisation called Un Llais that has been extremely effective in building capacity in the third sector, particularly in terms of developing advocacy support in the region in north Wales, but very recently, the health board has taken the decision to terminate the contract that it has with Un Llais, which, I believe, is detrimental to the work that the third sector is doing to support the improvements that are needed in mental health services across the region, especially in terms of advocacy support.
Can I ask whether you—given that this health board is in special measures—will be able to help review this decision to make sure that it is appropriate and that there are adequate services available for those who need advocacy support in relation to their mental health services? Because this is a concern that has been raised with me, not just from the third sector organisation that is affected, but also by service users themselves.

Vaughan Gething AC: Thank you for the question. I'm happy to say that we do monitor the provision of advocacy services across the country, and, actually, Betsi Cadwaladr currently meet our current standards to make sure that advocacy services are provided. We have quarterly assurance and reporting on the delivery of advocacy services. I can't go into the detail of the individual matter that you raise, but if you write to me with the detail of the nature of the concern, then I'll be happy to make sure that it is properly investigated.

Question 7 [OAQ52776] is withdrawn. Finally, then, question 8, Rhianon Passmore.

Out-of-hospital Cardiac Arrests

Rhianon Passmore AC: 8. What is the Welsh Government doing to improve the survival rates for out-of-hospital cardiac arrests in Islwyn? OAQ52789

Vaughan Gething AC: Thank you for the question. Last week, I issued a written statement providing an update on the implementation of the out-of-hospital cardiac arrest plan and announcing the establishment of the Save a Life Cymru partnership. The Welsh Government will now invest £586,000 to fund the first two years of that project.

Rhianon Passmore AC: Diolch, Cabinet Secretary. Last week in the Chamber, you announced that the Welsh Government was establishing a strategic partnership, similar to the one in Scotland, called Save a Life Cymru. The groundbreaking Welsh ambulance service's Restart a Heart campaign, launched last autumn, has taught nearly 13,000 schoolchildren life-saving cardiopulmonary resuscitation, which, alongside the Welsh ambulance's paramedic support for the access and availability of publicly placed heart defibrillators—highlighted by the dedicated Jack's Law campaign—has meant that public defibrillators in schools have already saved lives in Islwyn.
I'm also grateful for the support of my colleague and fellow AM Jack Sargeant on furthering these critical life-saving initiatives. How, then, will the Welsh Government monitor support and ensure that the communities of Islwyn are fully engaged in the Save a Life Cymru campaign to learn cardiopulmonary resuscitation, ensuring survival rates for out-of-hospital cardiac arrests in Islwyn? And what further role is there for rolling out public defibrillators across Wales and furthering Jack's Law?

Vaughan Gething AC: Well, of course I'm interested. There are a range of individual third sector organisations that are actively promoting the use of, and the funding of, defibrillators, including, actually, their monitoring and maintenance as well. What we try to do, as part of this work, is to bring those organisations together to understand where gaps do and don't exist.
I'm pleased that, yesterday, 75 secondary schools across Wales took part in the Restart a Heart initiative, learning basic life-saving techniques. And I myself have undertaken some of that training in the last two years, although last year, I was in Pembrokeshire with Joyce Watson, and we had to leave as there was a storm and they had to send all the children home because that's life when you're relying on the weather.
Look, I also know that there'll be more schools taking part in the coming days, including Islwyn High School, and that will be about volunteers with the Welsh ambulance service monitoring what's happening through the partnership. That will be monitored by the heart conditions implementation group, so there'll be oversight from people in Government, from within the health service, and the third sector, and, of course, I'll be more than happy to report back to this place on the progress that we are making.

Thank you Cabinet Secretary.

3. Topical Questions

No topical questions were accepted.

4. 90-second Statements

The next item is item 4, the 90-second statements. Siân Gwenllian.

Siân Gwenllian AC: Thank you. Every October, we celebrate Black History Month in Wales in order to give individuals and communities throughout Wales the opportunity to recognise the contribution of black people to the economic, political and cultural history of Wales. It's also an opportunity for the wider community to learn, celebrate and share our rich national history with the world.
We are extremely proud in Wales that our capital city was one of the first multicultural cities of its kind in the world, where people from diverse backgrounds live side by side happily and have done for decades. We take pride and share our diverse and rich history.
Unfortunately, we remember Wales's part in the horrific slave trade. We tell the tale of Somali and Yemeni sailors settling down in the docks of Butetown and Barry, and miners from the Caribbean working in the coal pits of the Valleys. We celebrate the contribution of the Windrush generation and pioneers such as Betty Campbell, the first black headteacher of a school in Wales, and also individuals’ contributions today, such as Uzo Iwobi, who is the race relations champion;RunganoNyoni, the Welsh and Zambian film director; and the poet from Cameroon, Eric Ngalle Charles.
Without a doubt, black people’s history is an integral and significant part of the history of Wales and the world and it belongs to us all. We will continue to celebrate and remember the contribution made by black people today, tomorrow and throughout the year.

The Deputy Presiding Officer (Ann Jones) took the Chair.

Janet Finch-Saunders AC: Last week, I was delighted to sponsor an event celebrating the success of Community Alcohol Partnerships. CAP is a community-interest company, and aims to tackle underage drinking by providing education programmes, engaging with local communities, and working with business to ensure that current alcohol legislation is adhered to and strengthened. Launched in 2007, it has since developed 162 schemes across Wales, including five new projects.
We have all seen the negative effects of alcohol misuse in our local areas. The normalisation of underage drinking has a profound impact on the long-term health and well-being of children and young people. That is why I am hugely encouraged by the success CAP has had in helping to reduce the number of underage drinkers. In its annual 2018 report, it notes that its projects have achieved a 60 per cent reduction in weekly drinking amongst years 9 to 11, and a 40 per cent reduction in youth alcohol-related antisocial behaviour. This is a fantastic achievement that will bring a positive impact to the many young people and local communities across Wales. Such a positive impact is a testament to the hard work and dedication of CAP's members, some of whom I was fortunate to meet last week. I am pleased that the Welsh Government has provided funding to some of the Wales-based projects. Given the proven success of CAP across the country, it is my hope that the Welsh Government continues to work closely with CAP to build upon recent legislation, including the Public Health (Minimum Price for Alcohol) (Wales) Act 2018, to reduce rates of underage drinking within our local communities.

Thank you.

5. Member Debate under Standing Order 11.21(iv): Foundational Economy

The next item is a Member debate under Standing Order 11.21(iv) on the foundational economy, and I call on Lee Waters to move the motion. Lee.

Motion NDM6782Lee Waters, David Melding,Jenny Rathbone,Hefin David, Adam Price, Vikki Howells
To propose that the National Assembly for Wales:
1. Welcomes the Welsh Government commitment to support foundational sectors in its economic action plan and calls on the Welsh Government to go further in embracing the principles of the foundational economy.
2. Believes that the Preston City Council’s community wealth-building approach has been demonstrably successful in tackling deprivation and calls on the Welsh Government to meet with representatives of Preston City Council to discuss lessons that can be learnt.
3. Believes that the Well-being of Future Generations (Wales) Act 2015 offers significant opportunity to reframe best value in the context of procurement in Wales, to support a foundational economy approach.
4. Calls on the Welsh Government to develop an ambitious adult social care models that recognises the importance of a localised approach and trials multiple alternative models of care delivery, as part of a foundational economy approach in Wales.

Motion moved.

Lee Waters AC: Diolch. Preparations are accelerating for a 'no deal' Brexit. Stockpiling medicine and food is getting the attention of the media, but the reality for the Welsh economy could be far more austere. Our economic policy has focused on providing support to so-called anchor companies—large multinationals with bases in Wales that we have favoured with grants and other financial inducements. But once barriers start popping up that create costly delays, the judgments made in the global head offices of where to put future investment will quickly disfavour Wales. As this week’s comments by Ford in Europe signalled, we may find soon that anchors are pulled up.
It seems to me that part of what we must do is confront the fact that we cannot continue to give large grants to huge corporations to entice them to stay in our communities when the going gets tough. The going is already tough, and we are pouring much needed resources into a sieve, watching our investments drained away to tax havens, for little lasting return on the ground. Wales has had great success in pursuing foreign capital. We've had record low levels of unemployment. We have record levels of foreign direct investment. And yet, many people are still profoundly disconnected, working in fragile jobs for low wages.
Llywydd, the economy isn’t just about GVA. It’s also about people’s lived experiences, and a foundational economy approach allows us to rethink. Almost half of the people in Wales are employed in what we might think of as the foundational economy: the mundane, everyday part of our economy; the parts delivering basic goods and services in their communities—care, food, energy and housing, to name just some—the parts that can’t easily shift when the international economy dips. And this grounded sector has been neglected by policy right across the UK as we’ve focused on the next shiny project, and the next ribbon-cutting opportunity. And we have to change that.

Lee Waters AC: The purpose of today's motion, tabled by myself, Vikki Howells, Jenny Rathbone, Hefin David, Adam Price and David Melding is to look again at the central importance of this overlooked sector of the our economy. From the cross-party buy-in to this motion, it is clear that there is an appetite for a new approach.
With my colleague Jenny Rathbone, I recently visited Preston to learn more about their approach to what they call 'community wealth building'. Since the financial crisis, and the failure of a grand new shopping centre that they were relying on to boost Preston, and in the face of continuing austerity, the council have been forced to rethink their approach to economic development. Now, their definition of an anchor institution is profoundly different to ours. They use the term to describe institutions that are locally rooted and securely based—the local university, the FE college, the sixth-form college, the county council, the local housing association and the police force. Together these anchors spent £750 million a year on purchasing goods and services, but just 5 per cent of it in Preston, and less than 40 per cent in the wider Lancashire area. So some £458 million of public money was leaking out of the Lancashire economy every year.
As a result of their new approach to harnessing their foundational economy these local anchor institutions now use procurement to secure the best social value locally. By auditing the 300 most valuable contracts they each had, they've been able to redirect spend to local firms without impacting cost or quality. That's a crucial point. Now, 17 per cent of the spending by the local anchor institutions is retained within Preston—17 per cent, up from 5 per cent—and 79 per cent in the wider Lancashire economy, up from 39 per cent.
This has had demonstrable impact in Preston. An area that was once amongst the most deprived in England is now rising out of the depths. Where wages in most of the UK have been static for over a decade, in Preston they're increasing. And a big contribution to that has come from the local anchor institutions. Five of the six are now accredited living wage employers.
We need to be doing the same—identifying who are the major players in our local economies and asking them to do their bit. We must be clear to all these institutions across the public and private sectors that building up their local economies will provide them with a secure foundation and a lasting future. For housing associations, their rents paid; for the health service, lower demand on services caused by poverty; for the police force, reducing the causes of crime. In Wales, the public sector spends £5.5 billion every year buying in goods and services, and we could use that as a direct means of boosting our foundational economy.
This will require a new approach, an approach that is in keeping with the Well-being of Future Generations (Wales) Act 2015, which as point 3 of our motion points out, offers a significant opportunity to allow us to go even further than Preston. But to do it we need to make changes. Our public sector will need to be empowered to procure in a way that delivers far more than the lowest price. Local businesses will need increased support to deliver and bid on public sector contracts, and we’ll need to invest in higher skilled staff in local government with specialist purchasing skills to drive this change in our approach.
But the barriers to do these things are not as high as we've convinced ourselves that they are. The experience in Preston shows that European procurement rules are not the problem we tell ourselves they are. In fact, the leader of the council, Matthew Brown, and his senior officials told Jenny Rathbone and I that the reforms have been much easier to carry out than they'd anticipated. So point 2 of our motion calls on the Welsh Government to meet with Preston City Council to discuss the lessons that can be learnt.
They stressed to us that their approach is not one that should be applied uniformly. Different places have different solutions and different problems to be dealt with.For example, in Islington, where affordable work space is in short supply, the council have invested in bringing buildings back into community ownership to let micro and small-sized enterprises rent at below market rates. That's been their focus. In Greater Manchester, the pension fund has provided £50 million of lending and equity capital to small and medium-sized enterprises. That's what they identified was their main problem. In Scotland, Highlands and Islands Enterprise have been a leader in the development of community energy assets, providing investment in an area overlooked by traditional financing.
Now, in Wales, we too have the kernel of a comprehensive approach. There are signs of a new attitude to purchasing. A review of the National Procurement Service presents an opportunity to move away from a focus on high-volume contracts for the lowest price. Our economic action plan commits us to supporting foundational sectors and we need to be clear about what we mean by this, and the extent to which it means jettisoning the old ways of working. But I was encouraged by what the Cabinet Secretary had to say about his plans for a cross-cutting foundational approach during his most recent appearance at the economy committee, and I hope we can hear more today.
But there is more to do. Point 4 of our motion calls on the Welsh Government to trial a range of different models of adult social care that recognises the importance of a localised foundational approach.Too often, people working in the sector are on low-paid, zero-hours contracts with no prospects of progression. Large firms are moving into the sector, and extracting significant profits for little return to care users and the public who fund them. Whilst we have given a £1 million to explore foundational approaches in social care, we give much larger sums of money to some of the worlds biggest companies to entice them to move or stay here, and we need to tip the scales, in social care and across our economy.
What I learnt in Preston, Deputy Llywydd, above all else, was that their success is due to focused leadership and vision. It has been embedded in the working culture of their anchors and through the sustained effort of committed figureheads. A foundational approach to the economy can be our vision, and the Welsh Government can take the lead. The dawning reality of what Brexit will mean for our economy means we need to do this urgently. Diolch.

David Melding AC: It's a pleasure to take part in this important debate and I'm pleased that in this fifth Assembly we have focused on this, the whole issue of the foundational economy, because I think really since the financial crisis there's been a great need to revisit how we look at the economy, because the economy has got to be much more than what can be captured by descriptions such as 'globalisation', 'rational markets' and 'maximum utility'. Economies are local, national, as well as global, and the local economy has been overlooked for far too long and, in my view, this has created a lot of space for populists and protectionists to grow in influence, and actually criticise aspects of the global economy that are quite productive for us, as well as focusing on issues that do need greater scrutiny.
But this phrase 'take back control' has to be taken very, very seriously. Of course, the tragedy in Brexit is that it's not very clear how we're taking back control. It'll certainly be a work in progress and it needs to be a work that informs the whole political economy, if I can use such an eighteenth-century concept, but I think it's time it came back, because politics and economics are so inextricably linked. We need, in looking at something like 'take back control', to consider concepts like fairness, worth, citizenship, because these are all key components of a cohesive society and a healthy political economy. They are inevitably promoted by the concept of the foundational economy, and Lee Waters has already given an excellent description of why this is so. And I believe also, as Lee mentioned, it's at the heart of something like the Well-being of Future Generations (Wales) 2015 Act. I do think that's a very good prism for us to use in terms of getting greater attention and focus on local economies and their growth.
Can I also take this opportunity to commend the Federation of Small Businesses and their partners in the report they've produced, and also the report by the Bevan Foundation, which I think is another key document? I notice that the Bevan Foundation urged the Government to come up with a strategy for the foundational economy, and to do that quickly. And they say it should be as urgent a task as the industrial strategy was for the UK Government, and it took them, they say, six months to put together. So, I do hope you will have that similar urgency.
Can I move to some practical issues, in terms of what we should be focusing on? A cleverer procurement, as is now occurring in Preston, which generates more local spend, is very, very important. Now, we could get mini protectionism if we're not careful. There's nothing wrong with people from outside the immediate locality being active in that economy. But we need to spend more within local areas—in delivering social care, for instance. It's an excellent way for those who are often economically inactive to be skilled up, given the confidence, and then being able to enter the local labour market. An awful lot of public service delivery can be concentrated in terms of the people they employ—in the more prosperous areas of a regional economy, for instance. And people travel in to places like Merthyr and the upper Valleys from Cardiff and the M4 corridor, when we could be generating more of that employment locally.
SMEs are clearly key in the foundational economy. And just look what's happened in the housing sector—we've lost a lot of our ability to build at scale, because SMEs have largely gone out of house building and into other related areas, like repair and maintenance and adaptation.
Skills are at the heart of this. If we could tackle basic skills deficits with the alacrity that we are now tackling higher skills and technological skills—and we need to do that, of course—we would see a reduction in economic inactivity. That is the main indicator of poverty levels—the number of people who are of working age but are not working. And this is a very, very important area.
Can I just finish with this, and it's a task beyond just the Welsh Government—this is something we're going to need to do at the UK level? Business rates are no longer fit for purpose. They drive local entrepreneurs out of our high streets, and in many areas around the business parks and the like. We are now in the absurd situation where local economies are paying more in business rates than some multinationals are paying in tax in all the business they generate in the United Kingdom. That cannot be right.

Hefin David AC: I'd like to say a big 'thank you' to Lee Waters and Jenny Rathbone for making the journey to Preston; I couldn't make it myself, for family reasons. But the great thing is, they produced a report, as you'd expect, as a result of their journey, and I've read it with interest. What it reveals is that there are things there that can be transferred from the Preston model to our communities, without too much trouble. I take the point about having local specific needs as well, but there are certain principles that we could transfer.
Professor Kevin Morgan has singled out, often, Caerphilly County Borough Council for praise, with regard to their procurement, and has named Liz Lucas and her team there as specialists and exemplars in procurement. So, I took the opportunity this afternoon to speak to the team in Caerphilly council, and one of the things that rang true was the line from Lee and Jenny's report on Preston:
'The council deputy chief executive in Preston told us that, having been told EU procurement rules were a barrier, they had found it easier than expected.'
And this is borne out by the experience in Caerphilly council, because what they did with the Welsh housing quality standard programme was that they developed their own Caerphilly version of a dynamic purchasing system, which allowed simplified access—something they called a passport to trade—for local contractors to access the work for the WHQS. This was something that fits very much in line with what I've read in the Preston report from Lee Waters and Jenny Rathbone.
One of the other things that Caerphilly said they do well is collaborate with other local authorities. And they felt that the National Procurement Service didn't allow that, or it wasn't built into the principles of the National Procurement Service, yet they maintained that collaboration locally. However, what I would say is that looking at the anchor institutions that are identified in the report that Lee and Jenny produced, as a result of the visit to Preston, there is not the level of systemisation and structuralisation that is present there in Caerphilly, and I think there are lessons to be learnt there: how do we make the most of the understanding of our immediate environment? I think that's something that we still fall some way short on.
I've talked before about Mark Granovetter's work, 'The Strength of Weak Ties' and the fact that weak ties to social capital are those that enable growth. So, not relying as a business on your family and friends, but relying on collaborative arrangements with other businesses in your immediate social network—that strength of weak ties in social capital.
One of the things Caerphilly found was that along with those weak ties come some very strong characters. Small firms that try and collaborate can't sustain the collaboration when they're applying and bidding for contracts. Sometimes, it's because of disputes over who should be paid what for what, and it becomes a difficulty in sustaining collaboration in small firms across contracts. They may succeed in delivering one contract, but then will not re-collaborate again to deliver another contract. That requires a degree of education in our small firms, in our SME community, and I think that's important.
Finally, the other issue that Caerphilly council raised with me is the link to social care. I'm pleased to see that one of our candidates for the Welsh Labour leadership is here and has identified the need for a national care service. I think a national care service is vital in helping us to deliver social care. Too often, we've outsourced our social care without thinking who we are outsourcing it to. The Wales Institute of Social and Economic Research, Data and Methods—WISERD—has produced a report, which said that we should be building social enterprises into our care delivery systems, into how we deliver social care. We haven't succeeded in that in Wales and I think we need to relook at how we deliver social care. I think that framework national care service will be key in allowing that.
So, I think this is an important debate at this point in time. We've had debates on the foundational economy before. One thing I'd say: the Cabinet Secretary has listened because we've seen it delivered in the Welsh Government's economic action plan, but now we need to see it actioned. I think that some of the discussion in this debate today will give the Cabinet Secretary further motivation to take these ideas forward, and I look forward to hearing his response to the debate today as well.

Helen Mary Jones AC: I'm very pleased to have the opportunity to take part in this important debate today, speaking on behalf of my colleague Adam Price. It requires real ability, political will and considerable courage to move away form the conventional ways of thinking in terms of economic policy, to move away from the obsession with the national economic indicators like GVA and GDP, an obsession that media and all political parties have been guilty of in the past, and to look at how we can better improve the everyday lives of our fellow citizens in real terms. GVA and GDP have, of course, a place in measuring overall national wealth, but what these indicators do not do is enable us to measure and understand real people's access to real resources, including financial wealth, let alone the health and happiness and well-being of our fellow citizens, and that, of course, is what really matters to people in their everyday lives.
The Welsh Government has in the past concentrated our economic policy on delivering the so-called 'big-ticket wins'—the anchor companies to which Lee Waters has already referred. There has been some success in attracting and retaining large international, mostly foreign-owned firms, to Wales. While one can see the attraction of this approach, it is problematic; it has always been problematic, but as Lee Waters pointed out earlier, it has become more problematic now.
There is, of course, immediate economic benefit, obviously, to those who are directly employed in these companies, and sometimes to local companies and supply chains, but in the end the profits are sent and spent elsewhere, and we know that the commitment of these multinationals to Wales, with some notable exceptions, is, at best, shallow. Too often, they will relocate at the whim of the markets, and this risk, of course, is heightened, as has already been pointed out, by Brexit.
There seems to be a consensus developing that we can't carry on like this. A paradigm shift is required in policy thinking. We must focus economic development more towards that everyday economy, which is relevant to all citizens in their everyday lives.Therefore, the new focus on the foundational economy in the Welsh Government's action plan is very much, I think, to be welcomed, as others have said. The foundational economy is made up of those basic goods and services distributed locally that are essential to life, including food, utilities, construction, retail, education, health and social care, and I very much take the point that Hefin has made about the importance of social care and how, in effect, we have outsourced much of that to big international companies that really don't care very much either about the people they're providing services to, their workers, or the communities they're providing services in. And, of course, housing is crucial. These sectors are where over half the people of Wales, of course, work, but we've tended to overlook them, in policy terms.
Working on prioritising the foundational economy will allow us to drive up wages in these key sectors as we improve productivity, and prevent leakages from local procurement and private consumption. Points have already been very well made about Preston council, and I'd be very interested to hear what contacts the Welsh Government has already had, and what further contacts they intend to have, with that very striking example. But there are, of course, other good examples, and others have mentioned those.
Of course, concentrating on the foundational economy would further allow us to retain a greater share of profits through higher local and social ownership. And this can be done in many ways. Plaid Cymru has been considering ideas, including establishing community economic development companies across Wales that can identify market opportunities for local co-operative enterprises and establishing an improved network and structure for the food and drink sector in Wales, bringing together all the various stakeholders across agriculture, food processing, health, nutrition and the environment. This could create a single joined-up policy that places healthy, nutritious and locally-produced food as a key overarching goal for the Welsh Government.
Like anything else in politics, refocusing economic policy is a matter of priorities. If the foundational sectors and the overlooked economy really do move up the list of priorities for the Welsh Government, and the signs are good—it is clear that there is movement on this—then resources can be better deployed to support, and policies better developed to engage with, the for-profit microfirms that account for over 30 per cent of employment in Wales.
We have to develop effective small business support, and, while there has been some success in the past, I'm sure we would all acknowledge that the previous models of small business support have, on the whole, failed to reach those businesses with the most potential to grow and which could use them most.
If we can get this right, we can positively influence the lives of large numbers of citizens, creating decent jobs whilst supporting growth and shaping the culture of the next generation of medium-sized grounded firms—that missing middle that we hear of. Many of the foundations and some of the institutions that can support the foundational economy already exist. The development bank, for example, has huge potential to build up the missing middle. However, it must move towards making long-term financial support for these Welsh-grounded firms through patient loans, where there's no expectation to be able to turn around a quick profit or a very quick return on investment, and to help local companies grow and, when necessary, potentially be bought out by staff themselves.
I can see, Dirprwy Lywydd, that my time is running out. There is much more that could be said.

It has run out.

Helen Mary Jones AC: It has run out. Thank you. Just to end by saying that this paradigm shift will require a lot of work, from Government, civil servants, the third sector, academics and other interested parties, to put together the body of evidence and to work to deliver. Plaid Cymru is very ready to play our part in this.

Jenny Rathbone AC: I hesitate to disagree with David Melding, but I'd just like to remind us all that the people who are living in most poverty are not those that are economically inactive. They are people in work; it's just that their wages are insufficient for them to live on. I was handed this at lunch time:
'Feeling peckish? Food for thought. In the past 12 months, 14 per cent of people in Wales had run out of food before they could afford to buy more.'
Those are mainly people in work. They simply aren't earning enough and that is a clear indication that the economy is not working for Britain and it needs fundamental reform.
So, I think, given the earthquake that could be posed by Brexit, we need to think really clearly on how we can develop a local economy that is resilient to these whirlwinds and fairer, using the resources rooted in our communities, paid for by our communities, rather than depending on those that can be spirited away to the most convenient tax haven. For example, as in Preston, with the failure of a large shopping centre, Sports Direct's takeover of House of Fraser is unlikely to be a source of salvation for Cardiff city centre. It's a stay of execution, but not a long-term solution to the changing patterns. It's as little rooted in its economy as is its landlord, which has interests across the UK and the United States. So, I think we really do need to focus on how we can strengthen our foundational economy, which is what we all have a stake in.
I commend, for example, Cardiff council on using community asset transfers when they are unable to find the resources to develop some of their capital assets, for example, by transferring Plasnewydd community centre to the YMCA, which is now a flourishing community centre, where it was failing in the past. The transfer of Roath library, which needed desperate repairs to its roof—it has now been transferred to Rubicon Dance, a local voluntary organisation, which many of you will know, who are better able to raise the non-public assets that Cardiff council is simply unable to secure at these difficult times.
Yesterday, in the Senedd, I welcomed the innovative housing award, which means that we are going to have a completely fantastic development of a tree tower of 50 flats for people, with affordable rents and in direct contrast to the rabbit hutches the six big house builders are so enthusiastic about. So, that will be building local skills, building expertise in the sort of houses we need for the twenty-first century, as well as putting more money into the local economy. Because if people aren't having to spend a huge part of their income on heating their home, it strengthens the amount of money circulating in the local economy to be spent on food and entertainment and anything else.
So, I think there are huge benefits to be learnt from our visit to Preston, which I think all our local authorities and all our anchor companies need to be thinking hard about. It doesn't just—. Also, the third sector plays a really important role in this. I visited my local British Heart Foundation furniture shop last week—fantastic opportunities for volunteering, which means that people who aren't well enough to take on local jobs or don't feel ready to go back into the workplace are nevertheless making a contribution, as well as ensuring that the students who all live nearby are donating the furniture they no longer need back into circulation for the next generation of students. That's a complete win-win.
One of the things that Lee Waters and I visited was the University of Central Lancashire, where the propeller initiative is making a big difference. They set it up as a business development hub, a worker-owned co-operative in digital media, to stem the brain drain to Manchester. So, this resonates with what David Melding was saying, that not all businesses need to be located in Cardiff. They could easily be located elsewhere in the Valleys, rather than clogging up the roads. So, whilst Cardiff University is hugely much bigger than the University of Central Lancashire, it is an important anchor company that one in 130 jobs in Wales depends on. The patents that they develop and the £29 million generated through student and staff start-ups indicate the type of new jobs that are likely to stay in Wales and stay in Cardiff in particular. Thank you very much, Deputy Presiding Officer.

Thank you. Can I now call on the Cabinet Secretary for Economy and Transport, Ken Skates?

Ken Skates AC: Diolch, Dirprwy Lywydd. I'm very, very grateful indeed for the opportunity to respond to this debate. I'd like to thank Members for their thoughtful contributions. Today, we have two debates back to back that I think reflect the twin goals contained in our economic action plan: one of supercharging the industries of tomorrow as we enter the, or as we proceed through the, fourth industrial revolution, and the second goal of supporting and driving inclusive growth. And I do think it's been an excellent debate. We cannot say this about every issue, but I believe there is genuine cross-party agreement on the importance of the foundational economy.

Ken Skates AC: I was struck by a number of contributions, including what David Melding said. His thoughtful contribution referred to the fact that there are many social, psychological and political impacts that the health of the foundational economy has. I think the latest publication concerning—or the latest excellent publication concerning—the foundational economy by Manchester University Press captures very well the fact that, when you have the provision of services and goods that vary in quality according to social status, you get societal division as a consequence. When that happens, you then have the sort of political opportunism that David Melding rightly identified, and also, of course, the protectionism that we've seen espoused around the globe on a national and on a regional and on a micro level as well.
I was also delighted and relieved to hear Helen Mary Jones speak in support of what I've stood here for more than two years arguing—that GVA is less important to people's lives than their happiness and their well-being, which can't always be captured by the existing measurements that too many politicians like to refer to when bashing a Government in terms of economic performance. The economic action plan is designed to raise the spirit level of, yes, wealth, but also—in my view, more importantly—of well-being, and to ensure that we drive down inequalities in both.
I think it's right that we, as elected representatives, regardless of party colour, should focus on the foundational economy, because, regardless of which constituency we represent, the foundational economy is relevant to us all and all of the people that we serve. It's at the heart of our communities and of our daily experiences, reliant as we are on the goods and services of the foundational economy.
So, it's not before time, in my view, that what has been referred to in the past as the 'mundane economy' is getting the focus and attention that it so richly deserves. Again, that's why the economic action plan gives a sharper edge to our approach to four particular parts of the foundational economy—those areas that concern food and drink, tourism, care and retail—where we will work across Government with these sectors to address three critical challenges, those, firstly, being to drive up the quality, sustainability and prospects of people employed within the foundational economy. Productivity, leadership and innovation are relevant to all of our economy, but they are no less relevant to the foundational economy.
Secondly, we need to change perceptions of work in the foundational economy—indeed, perceptions of the foundational economy itself. We need to drive up the value that every individual places on the role of the foundational economy in our society, because it's people and their skills and their commitment that make the foundational economy serve society successfully, and so we need to invest more heavily in the people employed within the foundational economy.
Thirdly, I believe that we must maximise the impact of the foundational economy on our places. Businesses and services and goods that form the foundational economy have a critical role in driving up the pride that people have in our places and cohesion in our places as well. So, our focus now is on developing an enabling plan that will have those objectives in mind and which will guide activity right across Government, because building a strong and effective foundational economy is not just about the economy and transport levers at our disposal—it's about joining up and making a collective and unified effort right across Government.
Turning to the specific elements of the motion, I do recognise the call to go further in embracing the foundational economy principles. I believe that there is a strong rationale for selecting the four foundational activities that I have. We have to start somewhere, Dirprwy Lywydd, and, with limited resource, having that sense of purpose and focus is incredibly important. But this does not mean that we cannot embrace wider principles of the foundational economy. Indeed, I've asked my ministerial advisory board to look at best practice and the lessons that we can learn from excellent examples like the Preston model of community wealth building that Members have referred to. I know that we already haveapplied lessons from Preston in our procurement policies, and learning from others is something that I'm very keen to do. Hefin David rightly said that it is entirely possible to adopt practices from elsewhere, that should be done whenever and wherever desirable, and Jenny Rathbone identified examples of innovation and best practice closer to home that should be rolled out widely across Wales.
And I very much agree with the emphasis placed in the motion on the well-being of future generations legislation. Embedding the ways of working and the national goals of the well-being Act provides great scope, in my view, for delivering wider value through procurement. I know that procurement resources are made available for use by the Welsh public sector to embed the well-being Act in delivery of procurement.
Dirprwy Llywydd, I recognise the motion rightly highlights the role of care, and the opportunity that we have to, I think, blaze a trail in looking at new models of delivery across our country. We have seen some really positive developments on this front; some Members have already identified some of those developments. We've engaged with the Wales Co-operative Centre to support the development and expansion of alternative delivery models that are far more sustainable, and serve the communities in which they are rooted. We've also undertaken a business support pilot in the Valleys taskforce area to deliver advice aimed at improving knowledge, confidence and practical skills. And our new approach, I think, provides us with the opportunity to potentially scale up such activities and engage more broadly with social enterprise and others in developing alternative business models.
Can I close by thanking Members once again for their contribution today? I very much hope that we can maintain the positive spirit of today's debate, and the cross-party goodwill, as we develop our approach to the foundational economy, and ensure that it goes from strength to strength.

Thank you. Can I now call Vikki Howells to reply to the debate?

Vikki Howells AC: Diolch, Dirprwy Llywydd, and my thanks to Members for their contributions to this debate today. I think we've had some very thoughtful contributions, covering a range of policy areas, and that's really important because, of course, the foundational economy does include so many varied aspects, from sofas to social care, the food we eat, the energy we consume, hairdressing to housing, transport to telecomms. Foundational activities cover the gamut of human existence and, moreover, they cover the goods and services to which all members of society require access. They underpin the welfare state and enrich our material experience.
For my closing remarks, I'd like to spend a little time reflecting on each part of the motion before us in turn. Firstly, as we note in our first point, it is really positive that the Welsh Government has committed to supporting the foundational sectors in its action plan, and that is no mean feat. As Helen Mary Jones stated, it takes courage to move away from traditional markers of economic success, such as GVA and GDP. And as the Cabinet Secretary said, it is all about supporting and driving inclusive growth, and it's great to see that he has the confidence to break free from the shackles of using GVA and GDP solely as signifiers of a nation's growth and success, and is genuinely, through the economic action plan, exploring ways to harness and to measure citizens' well-being.
But, as other contributors have made clear, it is imperative that the Welsh Government must go further in embracing the principles and the ethos of the foundational economy. Indeed, foundational economy activities provide 54 per cent of Welsh jobs, and 45 per cent of our GVA. Similarly, it is estimated that half of regular household expenditure is spent on aspects of the foundational economy.
To turn to our second point, we must learn from the work that Preston council has done in tackling entrenched local poverty, investing in the foundational economy by, as Lee Waters explained, redefining the concept of an anchor institution. Businesses and community organisations have been incubated there, and my colleague Jenny Rathbone gave some great examples of how this has also been done in Cardiff and can be emulated elsewhere. And this is the key point, in Preston, the £1.2 billion spent by public sector bodies has been aggressively deployed to benefit the locality. Local spend by the council, at least, has more than doubled, and the result has been that that area has enjoyed the second biggest shift in its multiple deprivation index ranking over five years.
Regarding the third strand of our motion on procurement, this is key to ensuring we support foundational economies across Wales, and there are examples of excellent practice in this area that can be harnessed and rolled out, as Hefin David informed us when he spoke about the expertise shown by Caerphilly County Borough Council.
If we could encourage this money to be spent locally, as happened in Preston, it could be used as a lever to improve the economic, social, environmental and cultural well-being of people and communities in Wales. As the future generations commissioner points out to us, this is not just a nicety, it is something that all public bodies are obligated to do under the well-being of future generations Act.
Now, the fourth point in our motion is a crucial one. I would strongly argue that not only is care a key strand of the foundationaleconomy but that also, by recognising it in this way, we can deliver better outcomes for all. However, as Sheffield university's Diane Burns has suggested, we need to introduce fundamental changes to the way that we do things. We need to change the way that we commission care. We need to change from care that focuses on it as a market-friendly commodity package service. We need to change from basing provision on businesses with no local commitments to those that have these. Indeed, we need to be ambitious and to look to see how we can rebalance services to get the best deal for local people, restoring people's feeling of worth and enhancing their skills, as David Melding so cogently argued.
To close, I hope that Members will support this motion today. Assuming a foundational approach to the economy is not about spending more of our finite resources. It's about conceptualising how we spend it in a different, better way and, as my colleague Lee Waters stated in his opening comments, finding tailor-made approaches that address the key weaknesses within the Welsh economy. It is also about ensuring and recognising the key role that these activities play in our economy, and I would suggest ensuring we view the activities that are part of the foundational economy, that underpin local communities and the welfare state—and those employed in them—as fundamental to our future prosperity.

Thank you. The proposal is to agree the motion. Does any Member object? Therefore, the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.

6. Debate on the Economy, Infrastructure and Skills Committee report: Industry 4.0—The Future of Wales

Item 6 on our agenda this afternoon is a debate on the Economy, Infrastructure and Skills Committee report, 'Industry 4.0—the future of Wales'. I call on the Chair of the committee to move the motion—Russell George.

Motion NDM6828Russell George
To propose that the National Assembly for Wales:
Notes the report of the Economy, Infrastructure and Skills Committee on its inquiry, 'Industry 4.0—the future of Wales', which waslaidin the Table Office on 17 August 2018.

Motion moved.

Russell George AC: Thank you, Deputy Presiding Officer. I move the motion in my name.
Now, all the inquiries that we do as a committee are interesting in their own way, but of all the inquiries that we've done on the committee since I've been the Chair of the Economy, Infrastructure and Skills Committee, I have to say this is the one where I have had my eyes the most opened—this is the work in regard to automation. We've heard some witnesses telling us of research showing that tens of thousands of jobs are going to be lost due to automation, and we also heard a study showing us that tens of thousands of jobs are going to be created as a result of automation. Now, I think I'm someone who is optimistic by nature, so I'm embracing the fourth industrial revolution, but there's a single takeaway from our work—it's that a government that fails to prepare for automation is preparing to fail. Of course, it's not just Government that this challenge is for; this is for business and service providers across the country. Automation is coming and we all need to think about what that means for us.
I was disappointed by aspects of the Welsh Government's response to our report, which might strike you as a bit odd because the Government accepted 11 of our 12 recommendations. There were no recommendations accepted in principle, which I was pleased to note, and we did have just one rejected. But as a committee, we're clear that our aim and purpose is to drive change. Our recommendations are intended to change and improve Government policy. So, when our recommendations are accepted but the accompanying text makes it clear that our concerns are not changing behaviour, then I'm concerned.
Recommendation 1 is a case in point: the committee calls for work
'to ensure Wales is the provider, not just the consumer of emerging technologies.'
But the response lists what the Government has done and it talks about the work already under way by Professor Phil Brown. It is not clear that we are in agreement here, so perhaps the Cabinet Secretary could respond to that in his closing remarks. In fairness, the Brown review may indeed cover the issues, and I will eagerly await publication to see what recommendations he makes. I'm fairly sure that Professor Brown's work won't be the end piece of work that needs to be done, and I hope that the Government stands ready to respond to any gaps or next steps he identifies.
Recommendation 11 follows a similar pattern of acceptance without fresh action. The recommendation is clear that we want to see more of the highest level researchers doing their work here in Wales and retaining those skills for the Welsh economy. The financial implications listed in the Government's response say that there would only be additional costs
'Should we launch a fund'.
Well, that's what the recommendation is calling for, Cabinet Secretary. So, I hope that the current budget round gives you the ability to do that.
I will look at recommendation 4, which is the only one that was rejected. This recommendation came from a suggestion by Professor Calvin Jones of Cardiff University that there might be real benefits for Wales in creating a model community to test emerging technologies in a Welsh context. It was an idea that received enthusiasm from others we talked to during the course of the inquiry, and the Government's response says it is working on a number of proposals rather than one specific location. Now, I do have sympathy for the idea that there may be benefits in testing in a number of locations rather than one single community. The important thing is less whether there is one or 10 sites; what matters is that there are sites in Wales that allow cutting-edge technology to be tested and developed to suit Wales's needs. I hope that these opportunities will be pursued. We won't get a second chance to be at the forefront of these emerging technologies.
I am pleased that recommendation 12 has seen immediate action. It was, I think, quite bizarre to learn that just one of the three regional skills partnerships had identified automation and artificial intelligence in their plans for future requirements, so I look forward to seeing the fruits of the Cabinet Secretary's letter in that regard.
The committee intended this report to be the beginning rather than an end to discussion, and the stakes could not be higher, but I'm particularly interested in Members' comments this afternoon and I'm looking forward to the Cabinet Secretary's response, particularly in regards to—. Perhaps he could outline in more detail some of the comments I've made about the recommendations I've put forward today and discussed.

Hefin David AC: I just wanted to concentrate on recommendations 3, 7 and 9 in my response. With regard to recommendation 3, which asks what the Welsh Government could do to harness expertise and contacts across Wales and within the Welsh diaspora, one of the things I'd say is there is progress being made in Wales in this area in universities, and they are involving expertise from across Wales and outside. For example, just earlier this year, I helped launch the Cardiff Metropolitan University's Cardiff school of technologies, which is one example of how higher education institutions can harness research and academic expertise.
I also last week helped launch the Supercomputing Wales programme, which is a £15 million programme of investment from Welsh Government and European funding, which is combining Cardiff University, Swansea University, Aberystwyth and Bangor universities to look at various different projects to develop computing intelligence to develop projects. One of the things that was most interesting about that, I found, was that it wasn't just about end products, such as the super car and microbiology; it's also about how we understand social science. Professor Roger Whitaker had a paper on networks and how computers can help us understand networks of social interactions between human beings. This is exactly what I was talking about in the previous debate when I referred to social capital. So, computers are helping us understand the complex socially constructed environment in which we live. I think that's massive and hugely interesting in how we develop our understanding of society. So, social science is playing a role there.
With regard to recommendation 7, which urges the Welsh Government to consider the role it should play in encouraging connected and autonomous vehicle—CAV—companies to sharepre-crash data to accelerate learning, I just want to draw the Chamber's attention to page 36 of the report. We had a very interesting exchange with Dr Nieuwenhuis, who told the committee that,
'a lot of cars out there are probably hackable today'
—connected and autonomous vehicles are probably hackable today—
'in fact, some of them have been hacked. So, what we need to avoid is a scenario whereby somebody with evil intent could suddenly hack tens of thousands of cars and use them to run over people in cities or something like that, which, theoretically, would be possible.'
I'd say it's not even theoretically possible: it's feasible; and certainly something that is entirely plausible in the environment in which we live today. In the Welsh Government's response, they say that regulation affecting CAV is non-devolved to Wales and, therefore, Welsh Government officials will engage with UK Government via the Department for Business, Energy and Industrial Strategy. Depending on the pace at which this technology develops, this may not always be the case, and I'm hoping that the current devolution settlement we've got won't be the permanent one. And should the Welsh Government ever take responsibility for this, then it's important that we keep our eye on what is changing in this area.
And, finally—. If I can find my papers—. I'm all over the place because I was preparing for the previous debate as well. Finally, with recommendation 9, it states that,
'In developing its vision for post compulsory education, the Welsh Government should refocus and redevelop its support for lifelong learning, creating new and accessible ways for workers at risk of displacement by automation in the first waves to retrain and upskill.'
And one of the things—. The main concern of the Welsh Government's response is the personal learning account pilot scheme, which would fund personal vocational retraining in sectors with a skills shortage. Now, that's all very well, but people need to know that their contribution has more than just a monetary value and that the contribution that they have to make will be valued when they leave education. And I would have liked to have heard more from the Welsh Government on that specific area as to how we are going to develop the vision within post-compulsory education and training. The Government will be developing legislation on this—on post-compulsory education and training—in the near future, and I think we need to understand that industry 4.0 will play a huge role in the development of education and training. And, I think, on recommendation 9, the Welsh Government's response falls a little bit short as to what I would expect to see, which, sort of, echoes the Chair of the committee's comments in his opening remarks.

Adam Price AC: I think it remains to be seen whether this is the swansong for me as a committee member in responding to this report, but—[Interruption.] Okay, calm yourself.
But I think the committee Chair was absolutely right: I think this has been one of the most fascinating and most far-reaching of reports. Just to focus in on one of the recommendations that the Chair referred to in terms of this idea of creating a test bed, I think this is an incredible opportunity for us, and I think the point about a test bed in a particular place—the real opportunity is actually in the combination of technology. So, actually, test beds exist, don't they, and living labs for particular ideas? And the idea of smart city pilot projects, they exist across the world. The interesting idea about building a cross-technology test bed, if you like—. People refer to it as building a city or a town from the internet up, fast forwarding the future, and it's the interconnection with the different technologies and building an urban laboratory where you can see the interaction between the power of mass-produced sensors and cloud computing and driverless cars, et cetera, all being built out in the same place. And there are, of course—. This is beginning to happen. So, in the eastern waterfront of Toronto at the moment, Sidewalk Labs, which is Google's urban innovations subsidiary company, is building an urban test bed, the first of its kind, for $50 million, just to give people a quantum of what we're talking about. Bill Gates is doing the same in Belmont, Arizona—an $80-million project there, which is combining these technologies for the first time. So, it's happening in the United States. No-one has built one in Europe yet. There was a proposal to do so in Portugal recently, but that hasn't as yet happened. Certainly no-one's done one in a rural context either. There are different questions about the rural context that Calvin Jones referred to in some of his remarks.
Of course, it's not just a technology test bed,it's a social innovation test bed, because you can't really test technology until, actually, you put the humans into the picture as well. It's how people interact with technology that is one of the key questions, and that's why the exciting thing about building a real test bed, which is a test bed at a human scale in a new planned community, is that it allows you to actually capture that knowledge. It's why the technology companies themselves are investing in this because they can see that, actually, if you're able to capture that data, then it actually provides you with a platform for innovation, which is very exciting indeed.
Why don't we build the first one in Europe here in Wales? The kind of figures that I've talked about there, they're not beyond the realms of our capacity, are they? And, actually, that would give us a brand. In some sense, what you're doing is building a showcase; you're building an open exhibition area, really, for Wales's offer in terms of AI technology. And, actually, $50 to $100 million, that's not a bad investment compared to some of the other things that we often invest in in terms of our economic development strategy. So, I would urge the Cabinet Secretary to look again at this. I've previously suggested—look—you could actually combine it with a bid for an expo. You don't have to go for the big one, but you could go for the smaller one, the intermediate one, which are built around specific themes. In 2027, for example, you could say, 'Well, actually, the community of the future, the AI community of the future, could be the theme', and you could build the test bed, effectively, as the expo site, and then it could continue as this kind of urban laboratory in future.
A couple of other things that we could do: the Massachusetts Institute of Technology, this week, has actually announced creating the world's first AI college. It took us 20 years in Wales to create a software university—I remember the pamphlet when it was first put out. Why don't we leapfrog the future and actually build an AI college? That could be a very, very exciting opportunity for us in Wales.
I totally agree with the need for a fund. Just to give you an idea, a city in China—Tianjin—has got a $16 billion fund for AI. That's just one city in China; Shanghai has got exactly the same. Both of them together are spending more on AI in that fund than we are doing throughout the whole of the European Union. If that doesn't smack us into action, then nothing will.

Vikki Howells AC: As previous speakers have noted, not only are we seeing existential changes to the Welsh economy, just as the economy undergoes changes—some good, some bad—so too does the world of work. The jobs of the future will belong not just to another time from the jobs of the past, in their opportunities, challenges and requirements they will also belong to another world.
I've enjoyed contributing to this inquiry, which, as the Chair has reminded us, is meant to be the start of a conversation about how we can navigate that future, and although the phrase has become something of a cliché, how we can ensure it is properly human centred. This is key to our ninth recommendation, which challenges the Welsh Government to put the retraining and upskilling of workers at the heart of its lifelong learning policy. The witnesses who spoke to us were clear in their evidence that low-skilled workers are most likely to be affected by automation and AI.
But women face an especial risk in the short term, for example, in the retail sector, where we have seen the rise of the self-service checkout. Incidentally, new research shows shipments of self-checkouts have continued to increase, with numbers up by 14 per cent for a second consecutive year. Moreover, we still have a task to do in identifying the skills of the future to look at demand and the types of jobs that might be required in any given locality. Here, there will be a key role to play for regional skills boards.
Furthermore, we need to develop a triangular system of exchange between employers, HE and FE, as Professor Richard Davies suggested in his evidence to us. We also need to understand how we can engage with those hardest-to-reach groups, who are perhaps most in need of upskilling, and I think there's a key role to play here for adult community education, particularly in that sector's ability to engage and develop community links. As this recommendation is key, I'm encouraged that not only have Ministers accepted it, but they have started to take action to meet this challenge. Lifelong learning must be just that. We should encourage a culture that recognises this and offers the resources and opportunities for progression, so I look forward to the launch of the personal learning account pilot next year.
Developing the skills we need should also make it easier for Wales to meet recommendation 1. This recognises that we need to ensure our economy produces as much as it consumes emerging technologies. At its most ambitious, perhaps we could reclaim the mantle of 'workshop of the world'. Evidence from the Confederation of British Industryand Professor Calvin Jones sketched out ways in which we could do this. Our universities have a key role to play here, and I was struck, on our visit to Swansea University, to see how that particular institution is responding to automation. Its engineering department has trebled in size. Its computer science department is undergoing similar growth. This must also be a key objective of the city deal programme, enabling that regional approach to the economy to be taken.
In the deliberations that led to recommendation 6, a made-in-Wales approach to precision agriculture, we took evidence on the ways in which this could benefit small farms. We have a clear need for this. We know the average size of a Welsh farm is just 48 hectares, and 54 per cent of Welsh farms are smaller than 20 hectares in size. However, its benefits are even more widely applicable than this.
I recently met with a company called CEA Research and Development. For those who are unfamiliar with the concept, 'CEA' stands for 'controlled environment agriculture', and this is a form of hydroponics that grows crops in a controlled, engineered environment. CEA Research and Development have ambitions, in collaboration with the Association for Vertical Farming, to open a new research and development facility to carry out R&D of engineering systems for the CEA industry in my constituency. There are numerous benefits to a CEA: no requirements for pesticide, better use of land, reduced water consumption, minimising of food miles, and, of course, insulation from what can be the very unpredictable Welsh weather. Indeed, crop failure and waste could be eliminated, and the duration from seed to product could be a little as a quarter of that under traditional agriculture. CEA Research and Development said Wales is a perfect location for this in terms of access to physical resources and, equally important, first rate academic facilities. I hope the Welsh Government will give this due consideration as part of the suite of actions it outlines in its response to the recommendation, and I look forward to revisiting aspects of this vitally important topic later in the term.

David J Rowlands AC: Can I refer back for just a moment, Dirprwy Lywydd, to the previous debate? Whilst I agree wholeheartedly with all the sentiments so eloquently put forward by Lee Waters, and, indeed, by all the other contributors, we must not forget that the public sector funds that will form the basis of the foundational economy can only be provided by a strong, industrial-based economy in Wales, which leads me on to my contribution to this present debate.
The future of industry in Wales is at a crossroads, and the decisions we make now will drastically change the Welsh economy for better or for worse. Do we embrace the new technologies, such as artificial intelligence, and potentially reap the financial rewards? Or do we risk falling behind those nations that are already embracing this technology? This is why it is imperative that we, in our position of responsibility, set the foundations for those new businesses to thrive, while ensuring that workers and established businesses have the support needed to embrace this new technology, thus ensuring no-one is left behind in Wales.
One of the biggest and most understandable fears of people faced with the introduction of new technology, such as artificial intelligence, is the threat of job losses. This is particularly so amongst low-skilled workers. Future Advocacy predicts that the proportion of jobs at high risk of automation by the early 2030s varies from 22 per cent to over 39 per cent. David Hagendyk, the director for Wales of the Learning and Work Institute, highlights this fear, stating that
'low-skilled workers will be the most affected by automation and artificial intelligence'.
However, the threat of job losses could, if handled properly, create a golden opportunity, an opportunity to upskill and retrain workers in skills that could not only accelerate the creation of new jobs, but could also gradually create a better quality of life, not only for themselves but for their families and communities too. Although the process of training these workers in unfamiliar and technical roles may initially be a costly exercise, it will prove to be hugely cost-effective in the future by safeguarding jobs and introducing a new and better skilled workforce. It is also the perfect opportunity to call upon the experience of already-existing tech and cyber companies, whilst utilising the expertise present in our world-class universities. With the help of these institutions, companies and industries venturing into automation can gain valuable training and insight. This will have the added bonus of keeping the training within Wales itself.
The opportunity to upskill and train cannot be limited to the current workforce. We, as law and policy makers, have a duty to prepare the next generation of Wales's workforce. It has been estimated that 65 per cent of children who entered primary school in September will end up working in job roles that are yet to exist. By failing to invest in them today, we risk jeopardising not only their future, but also the future of Wales, as high-tech companies may be forced to look for suitably qualified employees outside Wales. Whilst it is true that the decisions to create employment and bring new and exciting industries to Wales may be beyond our immediate control, we can, by developing and nurturing new skills in future generations, encourage industry to view Wales as the destination for innovative business.
In order to enable these future students to reach their full, unrestricted potential there needs to be a major change in both the curriculum and the environment in which these children are taught and brought up. In our committee's research, a number of expert witnesses, such as Dr Rachel Bowen, supported the findings of the Donaldson report, suggesting that if the Donaldson report was implemented properly, it could create learners who are fully equipped to deal with the challenges of the twenty-first century. It is our duty to ensure that future workers leave education with the skills to cope in a working environment that will be evolving and changing at a pace never before experienced.
It is our committee's view that the future of Wales's economy relies heavily on the Welsh Government's ability to embrace these new technologies and create an environment where there is an unparalleled opportunity for the existing workforce to upskill, and an education system that will equip future generations with the requisite skills and ability to adapt to an ever-changing work environment. Diolch.

Lee Waters AC: I agree with the Cabinet Secretary that this debate and the foundational economy debate are flip sides of the same coin. It looks likely that the fourth industrial revolution is going to generate huge wealth, but it's wealth that's not going to be shared evenly. It will be distributed unequally, which is why the stress of the foundational economy looking after left-behind communities is so important—because people will be displaced. There are predictions consistently around a third of jobs being affected, but it's not going to be as black and white as that. Some 60 per cent of routine tasks will be automated—it will affect all of us.
This is one of those areas where the fourth industrial revolution is happening despite Government, not because of it, and we're struggling to keep up. It's been more than two years that we've been debating this in this Chamber, and it's difficult, I think, for Government to keep pace with the level of change taking place in the economy. To be fair to the Welsh Government, they've instituted the Phil Brown review to look at the implications on skills, which is due to report initially in the new year, and I think that is an excellent initiative. Also, the Cabinet Secretary has made sure in his new economic action plan that future Government support is centred—one of the key pillars is on how it supports automation and the fourth industrial revolution. That's to their credit.
But I don't feel that we are really seizing the agenda. As the Government's response to this committee report makes clear, there's a lot of stuff happening, but I don't feel that we're really grabbing it and applying it in a way that can give us early-mover advantage. One of the committee recommendations is that we look to see how we can demonstrate our domain expertise—those areas where we have a genuine advantage. And there aren't many, but there are some where Wales has a genuine advantage. So, compoundsemiconductors is a classic example—we are world-leading in that field. We should be looking at how we can apply automation in those areas where we are doing well, so that we can become leadersin those areas where we already have some headway. We're not doing that, and the response to the report is disappointing.
I'd likeus to concentrate, mostly, on the precision agriculture element, because, again, it is a practical application of where we could have first-mover advantage in a particular subset. And in terms of Brexit, this is something that we can get ahead of—the implications of that—to give us some advantage. And Vikki Howellshas already talked about food production, which, again, is a feature of the foundational economy debate.
The Government's response I think is poor. Two years ago, we agreed in an individual Member's debate that the Government would publish a strategy on precision agriculture. That has yet to appear. The Government's response accepts recommendation 5 and recommendation 6, but, again, when you look at what they say, they don't seem to be willing to do anything different than they're already doing. Now, I accept that Government officials are up to their eyes in trying to deal with Brexit in the agriculture portfolio, but we really are missing a trick here. I would urge the Government to look again at this, as I have urged for two years, to no avail, because I genuinely feel we are really missing a key opportunity.
The evidence we took was persuasive. The benefits of precision agriculture are multiple. We heard from Professor Simon Blackmore from Harper Adams University about how, from an environmental point of view, the use of these technologies can significantly reduce the amount of pesticides and harm to the environment. So, for example, in his evidence, he told us of how they are now able to eliminate the use of herbicides and put chemicals directly onto the leaf of a weed, saving 99.9 per cent of the chemicals straight away—removing the need for chemicals and improving the quality of the plant, improving productivity on farms, and, post Brexit, that's exactly what we will need to do. But the Welsh Government—as we heard in the evidence—support offered to farms is not flexible enough, so Jason Llewellin, a farmer from Pembrokeshire, told us that he had to have 600 soil tests to be able to apply precision agriculture to his farm, but only 10 of them were available under the Government's Farming Connect scheme, and there's no real route to go on to the next level. Now, the Government just does not accept that in its response.
So, I just want to repeat what I've said before to the Ministers present that if you read the report, there's a compelling case about how we can apply this technology to Welsh circumstances—the types of farms we have, the smaller farms, the development of small machinery. We can lead the way here. There's great work being done in Swansea University, there's a cluster of expertise already around Aberystwyth University, and there's good work being done across the FE colleges in Wales in the farms that they own. We really can break through here, but we need to do more, and the Government simply isn't doing it, and I don't understand why.

Jack Sargeant AC: I'd like to start by thanking the committee for their interest in industry 4.0 and their work in this inquiry. It's something that I would have certainly loved to have contributed towards.
We're in the midst of a significant transformation regarding the way we produce products and that's thanks to the digitalisation of manufacturing. We should always remain focused on viewing the next industrial revolution as an opportunity and not a challenge. That doesn't mean pretending that there won't be challenges, because there certainly will be, but we should always remain ambitious about the future and what we can do to turn those risks into rewards, so from being able to identify opportunities to optimising logistics and supply chains, autonomous equipment and vehicles, robots, the internet of things, and the cloud. Now, as an engineer, I'm particularly excited about the potential for all sectors of our economy, and we can make that a reality if we get the investment right, and that's from infrastructure to education, lifelong learning, apprenticeships and continued professional development. Putting industry at the heart of our curriculum and taking seriously investment such as digital connectivity is crucial.
My constituency in Alyn and Deeside could be the hardest hit by manufacturing job losses. So, in the spirit of turning risk into rewards, we must act. This isn't an issue confined to the corners of north-east Wales or just Cardiff, it affects all of us, but it also can benefit us too. We should be planning to create tech hubs in the west of Wales, working on digital skills for programming, coding and development purposes. In the north-east of Wales, building on our world-class record of being home to some of the world's best manufacturing companies, with the right investment in digital infrastructure, we could enhance our capabilities by combining robots and our skilled workforce and allowing them to co-evolve. In other parts of Wales, we should redouble our efforts to attract global companies to invest in the autonomous vehicle market. This is something we should not be afraid of, and in rural Wales, as Lee rightly mentions, we should look at how AI and automation can further benefit our rural workers and farms.
Working terms and conditions, along with pay, are also concerns I know many workers have as we go through this period of change. But the question of how technological developments have impacted the core nature of our work is nothing new. It's an age-old question and it stretches back to the first industrial revolution. So, let's be bold, let's look at options like the universal basic income as a supplementary solution, let's look at how communities as a whole can benefit from the time that workers save through automation, making workers part of our communities again. I also believe that the Welsh Government should be looking closer at how it approaches and plans and responds to the fourth industrial revolution. Perhaps they should have a designated Minister complemented by a working group committee made up of experts from around the globe. This isn't a revolution that we can plan 10 years in advance for. This revolution is already here and we need to act urgently to adapt and to benefit.
Today, Llywydd, I'm wearing a recently purchased Apple watch. Its new features allow you to see more and do more just at a simple glance—I can see Lesley smiling at me now. Its assembly is 30 per cent smaller yet it contains 21 per cent more components, and at the heart of the watch there is an optical heart sensor that also allows you to quickly check your heart rate. It can detect if your heart rate falls below a threshold for a period of 10 minutes when you appear to be inactive, and that triggers a notification. That's healthcare automation before our very eyes. But we certainly need to do more and monitor the rate of change here in Wales of healthcare automation. The watch has been fundamentally redesigned and re-engineered to help you stay even more active, healthy and connected, and that must be the ultimate goal of this Welsh Government. Throughout this twenty-first century industrial revolution, we should fundamentally redesign and re-engineer policy to help people from across Wales.
Just finally, Llywydd, I'd like to thank again the committee for this work. It's a great report and a great achievement. Really well done to all the Members who've contributed. Diolch.

Thank you. Can I now call the Cabinet Secretary for Economy and Transport? Ken Skates.

Ken Skates AC: Diolch, Dirprwy Lywydd. Again, it's been a very thoughtful debate and I am very grateful to the committee for its work. Russell George at the outset said that if you fail to prepare, you should prepare to fail. This is something that was often said when I was in the officers' training corps. It's something that equally applies to economic development and many other areas of service provision. I firmly believe that our challenge in this regard is to futureproof the Welsh economy, and we have to get ahead of change in order to equip, not just our people and places but also our businesses to face the future with confidence. Our economic action plan is the main focus in futureproofing the economy of Wales.
It's worth saying that all previous industrial revolutions have led to the creation of more jobs than they have destroyed—the key difference being that the jobs created have often more advanced than those that have been lost, and so it's absolutely vital that our efforts should be placed most firmly on equipping people with the skills to take advantage of the jobs that will be created as a consequence of the fourth industrial revolution.
The economic action plan embodies three main strands of our approach to automation—firstly, the investment that's required in developing automation for its many benefits. Secondly, we need to educate and train the people for the jobs of the future, and, thirdly, we need to support workers in what will be, in many parts of the country, a difficult transition. We also need to empower workers to ensure broadly shared growth—again, reflecting back on the earlier debate that our focus must be on driving inclusive growth. The fourth industrial revolution should be utilised as a means of driving fairer growth and a fairer distribution of high-quality jobs across the country.
Automation and digitalisation is one of the five calls to action contained within the economic action plan. We engage very regularly with businesses and stakeholders to discuss the potential impact and opportunities of automation and digital technologies. I was particularly pleased, just this morning, to meet with CAF, who are building more than half of the trains that will be used in the coming 15 years and beyond. They'll be built at the Newport facility, and I was pleased to learn that the Newport facility will be the very first fully digitalised manufacturing facility in the CAF family—that as a consequence of working with Welsh Government to place very firmly the fourth industrial revolution at the forefront of their considerations in designing the facility, and in ensuring that the people who will be working there have the skills to take advantage of new and emerging digital technology.
In addition, Wales's innovative tech community, I think, is already considering the opportunities of artificial intelligence. M7 Managed Services, in partnership with IBM, recently opened an AI centre of competence. Through our Be The Spark programme, we're also helping to create the environment for tech start-ups to compete effectively and efficiently by stimulating and engaging everybody in the Welsh ecosystem to support innovation-driven entrepreneurship right across the length and breadth of the country. The Centre of Excellence in Mobile and Emerging Technologies, based at the University of South Wales, is supporting Welsh businesses to develop services through the adoption of artificial intelligence and other emerging technologies.
I think that harnessing the benefits from automation requires an infrastructure that supports the interconnectivity of devices in an automated environment. The economic action plan sets out our commitment to deliver fast, reliable broadband across Wales and to enable the market to roll out fifth-generation mobile networks.
Now, the need for highly competent and innovative Welsh businesses is higher than ever before. Our strengths already include compound semiconductors, nuclear and advanced manufacturing, and we're working to leverage funding from the UK industrial strategy challenge fund and EU funding to support these strengths. We have invested considerable sums in these areas of activity, and we will continue to do so, because—

Nick Ramsay AC: Will the Cabinet Secretary give way?

Ken Skates AC: —these are the industries of the future. Yes, with delight.

Nick Ramsay AC: Thanks for giving way. You've mentioned key components of this new economy—broadband, electric trains. I think this is a good time to plug the electric car infrastructure as well. I know it's not totally related to this, but, at the same time, that is all part of networks. We know that, at the moment, Wales is needing to play catch-up in terms of getting that electrical car charging infrastructure in place, so I hope you put that at the forefront as well.

Ken Skates AC: Indeed. I think the Member is absolutely right—there is considerable market failure in Wales, and this also applies to other areas of technological service provision. The reason that we've had to intervene so deeply in terms of superfast broadband is because of the market failure that we've had to tackle.
I think the Member makes a very important point about the automotive sector. We recently announced how the £2 million fund will be used to install electric charging points. We're hoping that we can use that as an incentive to develop more charging points that will enable cars to be charged at superfast speeds. I think it's absolutely essential that we use a limited resource in the best possible way, and that means futureproofing the provision of the charging points; it means investing in those charging points that are going to be able to supply power to cars more quickly. I'm particularly pleased that new technologies within the automotive sector are being developed right here and now in Wales. I'm delighted that Aston Martin Lagonda's new Lagonda electric powertrain will be amongst the most advanced on the planet, and that we will see it developed here.
Now, in March, we announced a review into the implications of digital innovation on the future of work and the Welsh economy, as Members have identified, and that work is now under way and being led by Professor Phil Brown of Cardiff University school of social sciences. We're looking forward to the outcome of the review in March, which, I can assure Russell George, will be addressing recommendation 1, and, if not fully, then I can assure him that further complementary work will be undertaken. We need to be very much alive at all times during the fourth industrial revolution to disruptive technologies that could be utilised by the Welsh economy, and within the Welsh economy, to give us a competitive edge. It will require, therefore, a constant degree of monitoring, evaluation, study and research. And I can also assure Russell and other Members of the Siambr that we will continue to develop strategic, mutually supportive and beneficial relationships with business, with academia and with communities to prepare our economy for the future.
Changes to the way that we work and the implications of automation mean that we need to rethink our approach to lifelong learning and to adapt our training and skills provision accordingly. Our employability plan sets out a range of measures to support individuals to develop and to adapt their skills to the changing needs of the labour market. Furthermore, technology and innovation, including the use of data, will help, as Members have identified, the farming industry to modernise and become more resilient and competitive and address its climate change and environmental responsibilities. Precision farming I don't think should be considered in isolation; instead, it should be considered as part of a broader agricultural and land use strategy post Brexit, and precision agriculture will doubtless help the sector address climate change and environmental responsibilities in line with the economic action plan.
Dirprwy Lywydd, I am conscious of time. Just reflecting back on the previous debate, it's often anchor companies, as large investors with the ability to be able to harness innovation and expertise from around the globe, that drive technological change, and I think it's a very dangerous assertion to make that we should cease support for innovation in companies such as Airbus UK, Ford, Calsonic Kansei, Tataand others in order solely to support the development of the foundational economy. Instead, we should see the foundational economy as the bedrock of the Welsh economy, driving inclusive growth, and the industries of tomorrow, which include those anchors that we have supported, as the drivers of the fourth industrial revolution that we need to work in partnership with.

Thank you. Can I now call on Russell George to reply to the debate?

Russell George AC: Thank you, Deputy Presiding Officer. I'd like to thank the Cabinet Secretary for his response. The committee did intend this report, really, not just to make recommendations to Government but it intended it to be a report and inquiry that raised awareness of some of the key ideas and concepts. We also wanted to challenge not just Government but business as well, and the third sector, because all of us, I think, need to think about the profound changes that are arriving at a great frequency.
Now, as I said at the beginning of this debate today, the stakes could not be higher. The evidence we gathered could not be clearer. We had clear evidence in our committee sessions; experts warned that thousands of jobs are likely to be in the balance in the very near future. Automation is a wind that could rip through the entire economy and leave devastation in its wake if we don't properly prepare. But, if we are prepared, there are, of course, enormous opportunities too, and that's what fellow committee members and Jack Sargeant picked up on in the course of our debate today.
Adam Price expanded on test beds and the need to build a showcase for Wales's ability, and the potential of AI—of an AI college, rather, which he outlined the case for. Hefin, of course, commented on driverless vehicles, and I know as a committee that we intend to do some more work in that area. And David Rowlands focused his contribution on Government needing to identify the needs, and business needing to identify the needs, in terms of creating the right workforce for the future. The fourth industrial revolution is happening despite Government, not because of it, was what Lee Waters said. Lee Waters, of course, talked at length in regard to precision agriculture. This is something I didn't have particularly strong views on previously. [Interruption.] Is it your quote, Lee, or is it somebody else's? [Interruption.] I'll give it to you. I think precision agriculture is something I didn't have great views on before doing this piece of work, but I can certainly say now that I share the views that I know Lee has held for some time.I'm gratefulto Jack Sargeant for his contribution, giving his perspective as an engineer, and an example he gave in terms of how AI can improve our healthcare as well.
I would like to thank a few people. We had a great range of experts during the course of our inquiry and most of them, if not the majority, were Wales based. We had evidence in regard to automated vehicles, precision agriculture—all good evidence. We also visited Amazon during the course of our inquiry and, across the road, Swansea University—visited their engineering department. As Vikki Howells pointed out, that engineering department is expanding. I think Vikki was probably as fascinated as I was at the robot we witnessed that was going to be looking after us, apparently, in our old age. Thanks also to the committee team that support us and the integrated team.
I think that this debate, although I'm closing it now, is very much the start of a much longer debate that I think needs to take place.

Thank you very much. The proposal is to note the committee's report. Does any Member object? Therefore the motion to note the committee's report is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.

7. Welsh Conservatives Debate: NHS Capacity

The following amendments have been selected: amendment 1 in the name of Julie James, and amendments 2 and 3 in the name of Rhun ap Iorwerth. If amendment 1 is agreed, amendments 2 and 3 will be deselected.

Item 7 on the agenda this afternoon is the Welsh Conservative debate on NHS capacity. I call on Angela Burns to move the motion.

Motion NDM6829Darren Millar
To propose that the National Assembly for Wales:
1. Expresses concern at the capacity of the Welsh NHS to meet demand for services throughout the year, not just in the winter months.
2. Notes that year-round pressures hinder the ability of the NHS to provide consistent and equitable access to out-of-hours, critical care and ambulance services.
3. Calls upon the Welsh Government to develop a comprehensive national plan to address pressures on out-of-hours, critical care and ambulance services to ensure that patients receive timely services which meet their needs.

Motion moved.

Angela Burns AC: Diolch, Dirprwy Lywydd. I'm pleased to open the Welsh Conservative debate tabled in the name of Darren Millar. We want to express our concern at the capacity of the Welsh NHS to meet demand for unplanned care throughout the year, and not just in the winter months, which is often much discussed here, because the truth of the situation is that pressures may look marginally different in winter, because there are a greater number of young children with bronchiolitis or frail people suffering from falls and chest conditions, but the hard reality is that these pressures are year-round, and a constant failure by the Welsh Government to tackle this challenge severely hinders the ability of the NHS to provide consistent and equitable access to unplanned care.
In the last 12 months, nearly 1,400 days—that's one thousand four hundred days—of extreme emergency pressures for Welsh NHS hospitals were recorded. Our hospitals operated under extreme pressure on 1,395 days over a one-year period in 2016-17. The pressure on the service, on staff and on patients is intolerable and cannot go on. Sickness rates in the Welsh ambulance service run at a staggering 8.8 per cent and, in 2015-16, the NHS in Wales lost over 948 person-years of work due to staff being absent with stress-related sickness. Therefore, we call upon the Welsh Government to develop a comprehensive national plan to address pressures in out-of-hours, critical care and ambulance services in order to ensure that patients receive timely services that meet their needs.
Now, it seems to me that improvements in these key areas depend on ensuring that people do not end up relying on those vital services because they're unable to access care in the local community in which they live. Getting a community-based model of care right is vital, especially as Government and health boards are seeking to transform the provision of secondary care. When areas such as west Wales see the delivery of healthcare being changed in a way that doesn't match the availability of services in the community it begs the question: how can we stop putting pressure on critical care, on out-of-hours services and on ambulance teams throughout Wales?
We've heard time and again that those of us who are lucky enough to live longer—and, with luck, to do so in our own homes—often struggle to get the appropriate support, usually because of a lack of resource available from social services. Whilst the aim of this debate is to draw attention to the Government's lack of integrated planning for unplanned care, I do accept that amendments 2 and 3, tabled in the name of Rhun ap Iorwerth, bring to the table a vital element, and we'll be supporting his amendments.
Deputy Llywydd, I can't take the Government's amendment with any degree of seriousness. Let me read this bit out:
'Calls upon the Welsh Government to support the implementation of a Healthier Wales to address pressures on out-of-hours, critical care and ambulance services'.

Angela Burns AC: Now, you may recall that 'A Healthier Wales', the Government's much vaunted vision and action plan, flowing from a parliamentary review, firmly puts social models of community-based health and care at the centre of health service delivery. The underpinning cornerstone of this direction of travel is to anticipate health needs and implement sustainable prevention and early intervention strategies in order to reduce the impact on poor health and the need for interventionist models of social care. The ambition is that people will only go to hospital when it is essential. Services will be designed to reduce the need to access hospital and to spend time there. 'A Healthier Wales' specifically states that there will be a 'shift in resources to the community', and this is good news if it enables pressures on the ambulance service and on out of-hours care and critical care to be reduced. So, the plan is to signpost people away from hospital and to community services. However, without the community services in place, people will still need their hospital, and, this year, some hospitals in Wales experienced their worst performances on record in the provision of emergency services.
Welsh Government is failing to strengthen the foundations of the NHS. We cannot build up a community-based model if we do not have 24-hour, 365-day responsive, preventative primary or social care provision. And how can that be built when spending on primary care by health boards decreased by 5 per cent in real terms from 2010-11 to 2017-18? This deterioration in services affects much of the patient experience and creates huge delays for people.
Cabinet Secretary, the most basic requirement for unplanned care is that it must be able to provide care quickly to people with urgent and emergency needs, and, as I've already said, the community will continue to rely on that. A 91-year-old constituent of mine fell and broke his hip in three places in a mental health unit located across the road from Withybush hospital in Haverfordwest. Staff at the unit were not allowed to get him up off the floor until medical professionals arrived. Cabinet Secretary, those professionals took five hours to arrive, and the poor chap was left lying on the floor for all of that time at 91 years of age. Fortunately, he eventually was collected by paramedics and was taken the staggering 380 yards across the road. It is only by chance that he lived through the experience given his age and the severity of the injuries. Now, we can and we must plan for our health services, but we must also have the flexibility to react to out-of-the-ordinary circumstances such as this, because I believe this story highlights that it's becoming increasingly challenging for Wales's emergency services to cope with winter pressures, summer pressures, and, indeed, all-year-round pressures.
Last year, the Welsh Government provided an additional £50 million to ease winter pressures and opened an additional 400 beds across Wales's NHS to ensure our services could cope with demand. Fellow Assembly Members, that is the equivalent of a general district hospital. However, there's been no indication that the Welsh Government will reallocate this funding this year despite demand for services growing throughout the year. Bed occupancy remains consistently above the recommended 85 per cent occupancy level, which means that patient safety standards are being compromised. In 2017-18, average daily occupancy was at 87 per cent within the Cardiff and Vale health board, reaching over 88 per cent at some times, and in Welsh Government-run Betsi Cadwaladr, it reached almost 88 per cent. That's a staggeringly high figure.
And the picture's even grimmer in the occupancy rates for acute medical beds. Within Abertawe Bro Morgannwg University Local Health Board, for example, it hit over 93 per cent. Already, we are rendered as some of the worst critical care services in Europe, and it's becoming increasingly the case that critical care beds are being used inappropriately and hospitals are having to cancel operations to ensure that these critical care beds can remain unused.
The Royal College of Emergency Medicine is calling for an additional 250 beds and funding that is specifically used to tackle delayed transfers of care. This would free up beds within hospitals and allow for a flow in the movement of people throughout the system. So, we're back to the crucial issue of funding. I'm not calling for more and more money, but for the money that is deployed into the NHS to be used more creatively. Every year, we get to a point where the Government says, 'No more money'; every year there's a volte-face as the pressure builds up. The problem is that this cycle is not sustainable, it doesn't allow for coherent planning and it means that funds inevitably get thrown at short-term problems, which makes for highly marginal short-term differences rather than a sustainable change. We need money, fundamental change, new outcomes, not pressure, money, pressure, money, pressure, money, or the picture will never change.
There's little transparency around the deployment of these funds. We cannot tell if the quick-fix delivers: were they value for money? Are we able to identify what they were used for? Whilst health boards may have been able to drive it through to the front line, the reality is it's probably just plugged financial holes, because to deploy effectively at the front line, you need human resource, and that cannot be switched on and off like a tap. And, ultimately, fixing the problem in the hospital is all about dealing with the rising demands in services, a lack of staff, the loss of too many beds, the lack of resources in the community and a diminishing level of proportionate funding for primary care. The very same GPs you asked to deliver an overstretched out-of-hours service, having allowed their funding to drop in real terms by 5 per cent, a service that should play an integral part in relieving pressures on emergency and unplanned services—it's not possible. There's no consistent access to out-of-hours services throughout Wales.
In ABMU last year, 19 per cent of all out-of-hour shifts were unfilled. Hywel Dda cannot fill some 1,500 hours of GP-led out-of-hours. On 12 separate occasions, Cardiff and Vale had no GP cover across the whole health board for a period of time, and in Aneurin Bevan, that situation occurred on 27 different days. In January of this year, almost 14 per cent of shifts were unfilled in Betsi Cadwaladr. You can see it's across the whole of Wales, and I merely illustrate that this is the very tip of the iceberg. When we have the Royal College of General Practitioners saying, and I quote,
'weaknesses in the system across the country are compromising patient care and increasing pressure on emergency departments',
then, surely, that is the time for the Welsh Government to realise that the situation in out-of-hours provision is critical.
Out-of-hours, ambulance services, critical care, unplanned pressures exacerbated by near collapse in social care. If you as a Government really want to cleave to the ambition set out in the parliamentary review, if you as a Government really want to transform services—as your fine words in the vision for health indicate—if you as a Government really want to deal with this never-ending pressure on our emergency services, on critical care, on out-of-hours or our ambulance services, then you need to look at the other end of the telescope, shift a measure of resources to primary and community care, fund and staff social care, and either support people appropriately in their homes or ensure that quality residential beds are available that match an individual's needs, invest in preventative care, respond to the dynamics of our population health trends, and focus on the integrated well-being of the people of Wales.
This is the hardest of choices for you, for the NHS and social care sector, and, truthfully, for us. You're obliged to meet the needs of today while planning, resourcing and funding the needs of tomorrow, but, at this rate, you'll spend the rest of your time as health Secretary firefighting, and you'll fall between two stools. You'll neither sustain our current systems adequately, nor will you affect the transformation that you seek and that we share with you.
To quote the parliamentary review:
'Unless faster, more widespread progress can be unlocked, access to and the quality of services will decline in the face of predictable pressures.'
This is why the next five years will be a crucial test. It's about priorities, Cabinet Secretary, it was always going to be about priorities, and I commend this motion to the Chamber.

I have selected the three amendments to the motion. If amendment 1 is agreed, amendments 2 and 3 will be deselected. So, can I call on the Cabinet Secretary for Health and Social Services to move amendment 1 formally, tabled in the name of Julie James?

Amendment 1—Julie James
Delete all and replace with:
1. Recognises the work that is being done to build the capacity of the Welsh NHS to meet demand for services throughout the year, not just in the winter months.
2. Notes that year-round pressures need to be recognised and understood to support the ability of the NHS to provide consistent and equitable access to out-of-hours, critical care and ambulance services.
3. Calls upon the Welsh Government to support the implementation of a Healthier Wales to address pressures on out-of-hours, critical care and ambulance services to ensure that patients receive timely services which meet their needs.

Amendment 1 moved.

Vaughan Gething AC: Formally.

Thank you. Can I call on Rhunap Iorwerth to move amendments 2 and 3, tabled in his own name? Rhun.

Amendment 2—Rhun ap Iorwerth
Add as new point after point 2 and renumber accordingly:
Notes that financial pressures that lead to poorer social care services contribute to increasing pressures on the NHS.
Amendment 3—Rhun ap Iorwerth
In point 3, insert 'social care,' after 'pressures on'.

Amendments 2 and 3 moved.

Rhun ap Iorwerth AC: Thank you, Deputy Presiding Officer. I move the amendments tabled in my name. It is encouraging, I think, that we appear to be moving towards having a more sophisticated understanding, now, that the NHS is facing year-round pressures, not just winter pressures, when extreme weather can generate pressures in the emergency care system. Now, the implications of this realisation are very clear—the NHS needs to plan for seasonal pressures, but what needs to be understood is that seasonal pressures are something that can happen across the year. Yes, there is winter every year, but it's highly likely we'll have spells of high temperatures more frequently in the future too, and we know that high temperatures can put a great strain on health services.

The Llywydd took the Chair.

Rhun ap Iorwerth AC: More often than not, it’s not the number of people who turn up at A&E who cause the winter pressures; more people attend A&E during the summer months. Of course, it’s not much use or help when many people who don’t necessarily need to be in A&E do turn up with a heavy cold, or because they’ve drunk too much. But, even if we prevented that kind of access to our A&E departments, then the winter pressures still exist, because the winter pressures relate, if truth be told, to the kind of patients, those patients who need to be there and come through our hospital doors because, usually, they are older and they suffer multiple conditions simultaneously, which, as a result, causes more complex cases. It takes more time and more expertise to deal with those illnesses. It’s more complex to treat them successfully. People like these need a longer period in hospital, and, very often, they can’t be released from hospital because of a failure to put social care packages in place that are appropriate.
Of course, the winter does make it more likely that a patient will be taken ill because of cold weather. When it’s slippery outside, it’s more likely that an elderly patient may slip. There are also additional problems caused, for example, by low-quality housing during the winter months. But warmer weather can also have an impact on these patients, by causing ill health, causing dehydration, sunstroke and so on and so forth. So, in the midst of these seasonal pressures, what we have, if truth be told, is a kind of patient who is more vulnerable, and understanding that means that we can understand which policies will, hopefully, be put in place in order to help the NHS to plan for the changes in patterns of usage—and that’s where our amendments come in.
Incredibly, we still have to highlight social care through our amendments, and highlight its importance in helping the NHS. It’s incredible that the Conservatives seem to be wedded to the idea that it’s possible to safeguard the NHS budget on the one hand, and to cut expenditure for social care on the other, without there being any sort of impact. I think failing to include social care in the original motion slightly dents your credibility in this regard. We will be voting against the Government amendment, because it would delete our amendments and makes the same careless mistake of failing to address the importance of social care.
To conclude, a few other policies that would be of assistance: investment in services to keep people healthy and out of hospital in the first place—that's preventative services, through social care services, medical care, out-of-hours care, which could assist people to receive treatment earlier when they’re ill, flu jabs—we know that there are current problems with the provision of flu jabs—and, as I mentioned a few minutes ago, low-quality housing. We need to think across all Government departments as to how we create a more robust population. There are things that we can look at in terms of flexibility and increasing flexibility among staff in hospitals in order to ensure that periods of bad weather don’t have such an adverse impact on staff ability to get to work, and through monitoring need in real time and defining that need in a more considered way than simply through figures alone, then we could respond by shifting staff and sharing facilities and so on and so forth.
Without doubt, preparing effectively for seasonal pressures is something that should be commonplace, and we, I believe, must see an end to the excuses that we hear annually, and we must be in a situation where we don't have to return to the same topic year on year.

Mark Isherwood AC: In seeking to delete our motion, which reflects the concern expressed to us by staff and patients throughout the year about the capacity of the Welsh NHS to meet demand, the Welsh Government is recycling lines that we have heard so often before. I've participated in similar debates throughout the last four Assemblies, and each time the Welsh Government has dodged responsibility by asking us to recognise the work that it is doing to build the capacity of the Welsh NHS. So, let us be absolutely clear: NHS Wales has been led by Labour health Ministers in Labour-led Governments since 1999.
Referral-to-treatment targets continue to be missed and the accident and emergency waiting times target has not been met in 10 years. Betsi Cadwaladr university health board has been under Welsh Government control for three and a half years. Welsh Government figures showed last month that Wrexham Maelor and Glan Clwyd hospitals had achieved the worst A&E performance for Welsh hospitals since records began.
A fortnight after writing to the health board about a constituent who had waited three years for a knee operation and who is in constant pain, we only received an acknowledgment from the health board yesterday, after having to chase this with their new chair. A constituent who spent three hours with a neighbour who subsequently died while he waited in the snow for an ambulance following a stroke, then suffered six months of procrastination and misinformation after complaining to the Welsh ambulance service. Only my intervention with the chief executive secured an apology and a response half a year later.
This summer, more than 5,000 hours were lost because ambulances were delayed handing over patients at north Wales hospitals. Bed occupancy rates consistently exceed the recommended 85 per cent occupancy level to maintain patient safety standards. Over the last two years, almost 75,000 NHS Wales patients had their operations cancelled for non-clinical reasons. It is now clear that unscheduled care services are not just under extreme pressure in winter, but all year round.
This is why our motion calls on the Welsh Government to deliver a comprehensive national plan to address pressures and ensure that patients receive unplanned and critical care services that meet their needs, including preventative services such as community and out-of-hours care. As the WLGA Conservative group leader Peter Fox said last week, in a document supported by local government leaders from all parties, with £370 million of new moneys arriving from Westminster, an imaginative approach to funding preventative services to keep people out of hospitals is needed.
On a frustratingly regular basis I've also raised in this Chamber cases of third sector bodies providing effective preventative services that have lost their funding because of dumb commissioning that is adding millions to the cost pressure on statutory health and care services. At the request of campaigners I formed CHANT Cymru—Community Hospitals Acting Nationally Together—in the second Assembly, to campaign against the Labour Welsh Government's community hospital and bed closure programme. We promoted at national level the role of community hospitals in providing quality accessible local healthcare and reducing pressure on our general hospitals. After 2011, Labour pushed ahead with the closures, with the inevitable consequences we warned of.
The Welsh Government's policy of strengthening primary care and community based settings is not being matched by resource allocation. If patients are to receive care closer to their homes, it is imperative that general practice is properly resourced. In 2014, the Royal College of General Practitioners warned that the share of Welsh NHS funding for patient care in general practice had been falling for years. A BMA survey in 2016 found that 82 per cent of GPs were worried about the sustainability of their practice in Wales. In 2016, the vice-chair of the north Wales local medical committee stated, 'I cannot stress enough how near the edge things are, and how the time for action is now or never.' In 2016-17—the most recently available figures—Welsh general practice received the lowest share of NHS health spend in the UK, despite a rise in patient demand. Last week, BMA Wales figures showed that 21 GP practices have closed since October 2015, with a further 82 at risk and 29 now health-board managed, with the largest number in north Wales.
In pursing this agenda, some might say that the Welsh Government had been putting ideology before patients, where BMA Wales also provided evidence that managed practices do not provide value for money and that health boards are actively seeking to return them to independent GP contractors. Well done, Minister.

Dawn Bowden AC: In my opening remarks and in direct response to the Conservative Members opposite, and particularly the remarks in Mark Isherwood's contribution, I ask whether they feel that the £4 billion extra that Welsh Government could have had if the block grant had kept pace with the growth in the economy since 2010 might have been one useful way for Wales and our health and social care service system to respond to some of the pressures that they describe. And in exactly the same way, whether they think it would be useful to know exactly how much money Wales is going to be getting from the Prime Minister's recent unfunded NHS birthday pledge, or how much extra money Wales is going to get from the end of austerity, as the UK Prime Minister now leads us to believe is about to happen. Because even though the Welsh Government and partners are well advanced with planning for the winter ahead, they do so without certainty as to when the extra funding is becoming available from the UK Treasury.
Last week, the party of austerity were calling for more money for local government services. Now they want more spending on capacity in the NHS. I don't think the irony of this going to be lost on the people of Wales.

Darren Millar AC: I'm very grateful to you for taking this intervention. You will surely recognise that the situation that the Conservative Government inherited back in 2010, in terms of public finances, was absolutely horrendous. Gordon Brown brought our country to the brink of bankruptcy, and this responsible Conservative Government has turned that situation around.

Dawn Bowden AC: Well, of course, Llywydd, it is only the Conservatives that still believe that lie, but there we go. So, as the debate—[Interruption.] So, as we debate the issues here, and quite rightly focus on the responsibilities of our Welsh Government, I for one am not forgetting the responsibilities of the UK Government in funding Wales correctly. And if you don't like it, let me ask the former leader of the Conservatives or the current leader of the Conservatives if they can show me the letters that they've sent to the UK Government demanding more money for Wales. And I bet they don't exist.
But to turn to NHS capacity—

Andrew R.T. Davies rose—

Dawn Bowden AC: I'm not taking another intervention. To turn to NHS capacity—[Interruption.]

She's not taking interventions. Dawn Bowden, you can carry on.

Dawn Bowden AC: To turn to NHS capacity, the response that we need to make, as recognised by the new national plan for health and social care, is a whole-system response. And that recognition is entirely missing from the Conservative motion. It's worth remembering that, here in Wales, we already treat the health and social care services together, and that 'A Healthier Wales'—the Welsh Government's long-term plan—will accelerate progress in that area, backed by the £100 million transformation fund.
By contrast, England has pretty much ignored social care, which has meant that, when pressure is increased, the strain is heaped on the NHS there, with no capacity to get people out of hospital. And while the Tories continue to criticise Wales's successful ambulance response model, and say that we are moving the goalposts to achieve better target outcomes, it's interesting to note that both England and Scotland are now replicating it.
But a whole-system response will go beyond out-of-hours, critical care and ambulance services, as is mentioned in this motion. It also needs to focus on the role of social care and on strengthening primary care. And in Wales, thanks to Welsh Labour, we have a planned health and care system that allows for that type of response. We know that in successive budget rounds, this Welsh Government has provided money to help with the integration of these vital services, and, thankfully, our services have not been broken into bite-size chunks, ready for privatisation. So we have the potential to make further improvements.
As a member of the health committee, I've read with interest the work of bodies like the Royal College of Emergency Medicine. In a report on their UK-wide winter flow project, they've highlighted the fact that we do need to focus on the care needs of patients who've been medically optimised and are fit for discharge back into the community. The royal college describes this as the exit block that we can open through further strengthening our social care packages. While we've made some progress with this in Wales, clearly there's a lot more that can be done, and of course we all know that being able to move patients out of hospitals as quickly as possible also improves patient outcomes.
From evidence that we've heard in the health committee across a range of issues, I believe we also need to continue to address the variations in practice and performance between health boards. I think, Angela, that was the point that you were making, because I do find it simply unfathomable that when a health board establishes a successful work practice, for example, the Cwm Taf discharge from ambulances at the front door of the hospital, why that isn't quickly replicated elsewhere. Likewise, I think the systems of triage need to be backed more robustly. For example, if someone is in accident and emergency and that's not the service that they require, we should enable hard-pressed NHS staff to more firmly signpost them out of that part of the service.
I understand that the royal college is asking for an increase in bed capacity, and that's for the Government to consider as part of the new national strategy, but the royal college also focused their advice on optimising patient flow, on reactive steps to help capacity, on engaging and empowering the wider system, and on a workforce strategy. So, whilst the motion is useful, it is in my view too narrowly focused, which is why the amendment, I believe, presents a better picture of the response that we can make in Wales to meet the demands of our health and care services, and why I will be supporting the Government amendment and voting against the original motion.

Janet Finch-Saunders AC: I would certainly like to support our own proposals to establish a national plan that aims to deliver a more sustainable out-of-hours critical care and ambulance service that will meet the needs of the Welsh people. Under this Welsh Labour Government, the NHS in Wales has increasingly continued to underperform. These issues have been particularly acute in Betsi Cadwaladr board, which covers my own constituency.
Betsi has seen significant issues with the performance of A&E departments. A Statistics for Wales report on A&E waiting times, published in 2018, shows 68 per cent of patients waiting more than four hours to be seen, going worse in August 2018. Two hospitals in north Wales achieved the worst A&E performance for a Welsh hospital since records began. Wrexham Maelor saw fewer than half its patients within the Welsh Government's own four-hour target time. Ysbyty Glan Clwyd had a rate of 52 per cent.
Pressures on the ambulance service have been compounded by system blocks at our hospitals causing significant delays in ambulance handovers. Almost 5,000 hours were lost to handover delays as Wrexham Maelor, Ysbyty Glan Clwyd and Ysbyty Gwynedd between April and June of this year. These figures come after the north Wales senior coroner and assistant coroner recently highlighted concerns regarding ambulance waiting times in their regulation 28 notifications.
Further—[Interruption.]—GP-led out-of-hours services, which are an integral aspect of relieving pressure on emergency services, are also under pressure. It woke the Cabinet Secretary up, I think that did. The Wales Audit Office's 2018 report on the state of out-of-hours services states that such services are not meeting national standards due to morale and staffing problems. Research from BBC Wales and the Wales Audit Office shows that the Betsi board could not fill 2,082 hours of GP out-of-hours shifts. This means that 462 individual shifts were empty, escalating pressures on A&E services, especially for non-urgent cases.
Whilst those who work in out-of-hours critical care and the ambulance service continue to provide a fantastic level of care to patients, and we salute them all, these figures clearly show that they are simply failed by a lack of leadership, and I tell you: that lack of leadership comes from here. My constituents are fed up with a severely underperforming health board that has seen standards fall continuously, and a health board in special measures for three years.
It is not just our constituents who are fed up. A former senior manager in the Welsh NHS, Siobhan, is now leaving Wales following several failings in the care of her husband, and I didn't like the way that her arguments were dissed in this Chamber earlier. She argues that there is a void in Welsh Government and that health boards are not being controlled by this Government, nor are they accountable to people. This is happening because of the failings of your Government—leaderless, incapable and incompetent. That is the legacy of this Welsh Labour Government.
It is, however, encouraging to hear of the Prime Minister's recent commitment to invest an extra £20 billion a year in real-terms funding into the NHS. This means that the Welsh Government will get a funding boost of £1.2 billion a year. Long-term funding must now be invested wisely by the Welsh Government, particularly into critical care and ambulance services. Therefore, I urge the Welsh Government to work with health boards to develop a comprehensive national plan to address the issues currently experienced by the critical care and ambulance services. I also urge the Government to commit more resources to preventative services to reduce unnecessary attendance at emergency departments whilst the £100 million transformation fund is being implemented.
Cabinet Secretary, it is not the first time I have almost pleaded with you and begged for you to actually show some mercy, really, on the many patients who depend on our hardworking nurses, consultants, doctors, general practitioners and our care-in-the-community workers. The fault lies here—not in this Senedd, but with you, the Welsh Government, here in Cardiff. Please, Cabinet Secretary, I ask you again, not only for the sake of my constituents in Aberconwy, and your patients, but for all of the patients across Wales and their families.

Gareth Bennett AC: Thanks to the Conservatives for bringing today's debate. UKIP supports their motion today. Like them, we acknowledge the problems with capacity in the Welsh NHS. Like them, we acknowledge that the pressures on the NHS are year-round pressures that do not just hit patient care in the winter months. And like them, we acknowledge the need for some long-term strategy, which here they're calling 'a national plan', to address these problems, rather than the sticking-plaster solutions that we seem to get year after year from the Welsh Labour Government here in Cardiff Bay.
We also support the Plaid Cymru amendments, which state that we also need to have a long-term strategy of funding social care, because if we keep on with the firefighting approach to health and social care, which Rhun ap Iorwerth referred to earlier today at health Minister's questions—I prefer to call it the sticking-plaster approach, but it's essentially the same thing—then that will also lead to increasing pressures on the NHS.
We acknowledge that the Labour Government have a plan, which they refer to in their amendment, but time is rather against their arguments now. They've had control of the Welsh NHS for the past 19 years, and health outcomes for many people in many parts of Wales still appear to be getting worse. The Labour Government have been plagued by public dissatisfaction over their running of the NHS since the very first term of the Assembly, and they're still facing essentially the same problems that they did then. As we know, and as has been mentioned, today we still have several health boards in special measures and targeted intervention.
The Welsh Government is now spending approaching 50 per cent of its budget on health. The upward trend surely cannot be allowed to go on indefinitely. We do need to move towards more preventative spending, as has been advocated by the future generations commissioner, among others. There was a proposal that she put forward that, in the long-term interests of the Welsh public, we needed to ring-fence at least a certain amount of the health budget and say that that was to be set aside for preventative spending. So, it had to be investment, for example, in promoting activities that might prevent obesity from occurring, rather than spending it on dealing with the effects of obesity.
The idea of preventative spending seems to me like a good one, but putting it into practice has proven difficult. We've ended up with an argument over what exactly constitutes preventative spending, so we now need to come up with a definition for this before such a policy can take shape. I don't want to get into the mechanics of what is and what isn't preventative spending today, but I feel that we must move towards a more strategic and more long-term approach, and I'm not convinced that the Welsh Labour Government is moving in that direction. So, that is why UKIP today supports the motion and the Plaid amendments and opposes the Labour amendment. Diolch yn fawr iawn.

Mohammad Asghar (Oscar) AC: If we are to relieve the pressure on our NHS, we must address the issue of support and resources for preventative services. One such service is out-of-hours care. The fact is that GP-led out-of-hours services are vital in relieving pressures on emergency services in Wales. The Wales Audit Office recently produced a report and a survey that found that nearly 700,000 people contact the out-of-hours service each year in Wales. Of the staff who responded to the survey, 66 per cent said that services are not flexible enough to meet the peaks and troughs in demand. Forty-six per cent disagreed or strongly disagreed that morale was good. It is clear that while out-of-hours services are appreciated by patients, national standards are not being met due to staffing issues and poor morale.
My own local health board, Aneurin Bevan, could not fill about 2,300 of GP out-of-hours service shifts. On no less than 27 separate days, there was no out-of-hours cover across the entire health board for at least 30 minutes. In the six months between October 2017 and March 2018, there was no GP out-of-hours cover across the entire region for over 53 hours. For a five-day period in February, more than half of the GP out-of-hours shifts were unfilled.
The Royal College of General Practitioners has published an action plan for this service. This action plan calls for steps to be taken immediately to address the crisis. They say that weaknesses in the current system across the country are compromising patient care, and increasing pressure on emergency departments. The college outlined that they called for five essential and achievable steps to help turn around GP out-of-hours care in Wales. These include addressing the vital issue facing general practice in the current climate.
In spite of Labour manifesto commitments to improve GP access, it is becoming increasingly difficult for patients to access their GPs. A BBC news investigation earlier this year found that the patient can only see their GP later in the evening in two Welsh health board regions. Across Wales, in seven health boards, only a quarter of GP patients were offered appointments up to 6.30 p.m. in the evening twice a week, and only 20 per cent of Welsh GP surgeries were able to offer early-morning appointments before 8.30 a.m. at least twice a week. No wonder that the chair of BMA Wales's GP committee said, in his words,
'With the lack of resources and no new investment in out-of-hours services, it is no surprise that GPs are feeling too exhausted to work out-of-hours.'
The pressure on GPs is now acute. The number of new GPs joining the workforce in Wales is now at its lowest level for a decade. Just 129 GPs were added to the workforce in 2016-17. The number leaving the service is now at its highest level in the last two decades; 212 left the service over the same period, which is much more than actually came in. 
Presiding Officer, this motion calls on the Welsh Government to develop a comprehensive national plan to address pressure on out-of-hours care, critical care and ambulance services. I believe such a plan would deliver significant improvement for patients in Wales, and deserves the support of this Assembly today. I hope that the Minister is listening. Not everybody in this Chamber, but at least this side of the Chamber we are all looking forward to seeing a better health service in this country. You've got more than one third of this budget, but where are the services to the people? I have yet to see them. Thank you.

Dai Lloyd AC: It's a pleasure to take part in this debate today on the capacity in the NHS here in Wales. Of course, as has been said, the health service here in Wales is under great strain throughout the year. In my practice in Swansea, we have a couple of hundred phone calls from patients every morning of the week, and there was one Monday a couple of months ago when we had 700 calls. Then, as GPs, nurses and so forth, we have to cope with that great burden, in a situation, of course, where we have a shortage of staff and also a shortage of resources to look after these people.

Dai Lloyd AC: Of course, under these circumstances, staff in the NHS, as we’ve heard already, do excellent work under very difficult circumstances, which are complex, and they are so very busy, it’s very difficult to be able to convey how busy we are, often, to people who don’t work under those conditions.
So, there are three things to say about this debate on capacity in the NHS. Yes, there is a staff shortage, in the first place. If you name any profession working in the NHS, you need more of them—nurses and GPs. We’re short of about 400 GPs here in Wales. There are about 2,000 GPs in Wales and there should be about 2,500, and we have fewer doctors per capita in Wales than in the majority of other countries in Europe. Among our specialists in hospitals, about 40 per cent of consultant posts are vacant posts in our hospitals here in Wales.
So, of course, with such a busy system and a staff shortage, of course we’re going to have waiting lists, people having to work far too hard and so forth and so on. That’s why, as a party, we want to open a new medical school in Bangor. We have to train more doctors in the first place. We have to develop more of them, because we don’t produce enough doctors at present, and even if everyone who graduated these days stayed to work in Wales, we still wouldn't have enough doctors in Wales to serve our population.
Another element of the capacity is a shortage of beds, which has already been mentioned. There are several royal colleges that say this, and sometimes it’s not fashionable to talk about bed shortages, because over the last quarter of a century we’ve lost several thousand beds in our hospitals and in our care homes here in Wales. Why is that important? Well, with an ageing population, there is a range of people who are too ill to stay at home, even with whatever intensive package you have supporting them. But despite the fact that they’re sick and they’re so vulnerable, they’re not seriously ill enough to take a bed in an acute ward in a general hospital like Singleton or Morriston. There’s always a range of patients who fall between those two stools, and we can’t deal with them very well these days in the absence of beds in our community hospitals.
The final point that I’m going to make about capacity, of course, is the fact that the majority of capacity here is outside the health service. I’m talking here about social care. The social care situation in Wales, as in the rest of Britain, is very vulnerable at present because of significant underfunding over the years, which means that there is a very high threshold for you to be able to access services from social services. But, basically, if there is no social care, there won’t be a health service. That’s why, in the first place, we need to tackle social care. Time is short now, because we can’t offer any kind of support to a great deal of our population at the moment. That’s how serious the situation is. And that’s why, as a party, we’re looking to reconfigure, radically, the social care system by creating a national social care service that will operate like our health service, and alongside our health service. We have to do that, because, at present, we can’t offer care to our most vulnerable people who most need that care, and the resources are just not available. The time has passed to just take small measures at the margins; we need a radical solution, and a new national social care system that befits our country. Thank you.

Caroline Jones AC: I'd like to thank the Welsh Conservatives for bringing forward this important debate today. Our NHS is facing unprecedented demand. In the past 12 months, there were well over a million visits to A&E departments around Wales. Over four in 10 of us find it difficult to make a GP appointment and operations are routinely cancelled due to a lack of beds. While the Choose Well campaign is a step in the right direction, it is going to take much longer to totally re-educate the Welsh public. It is so ingrained in the public’s mindset that when they get ill they need to see a doctor that convincing them that, sometimes, a community pharmacist is a much better option is going to take a long, long time. When you couple this mindset with the fact that it is getting harder to see a GP because of underfunding and over work, it is no wonder that people inappropriately turn up at the A&E department.
We have to be bold if we're going to ensure that ambulances queuing outside our A&E departments are a thing of the past. We have to be bold if we're going to ensure that our hard-working NHS staff no longer feel that they're working in a war zone. And we have to be bold if we're going to ensure our NHS has a future. We know that over a third of those attending A&E would be more appropriately dealt with elsewhere in the NHS, which is why I wholeheartedly support both the BMA and the Royal College of Emergency Medicine, which have suggested we look at co-location of primary care services and the use of front-door physicians. We also have to look at introducing a single point gateway service that can funnel people to the appropriate service. The 111 service is a step in the right direction, but it needs to be rolled out faster and have a much wider remit.
We have limited resources in terms of doctors and nurses, and quite often a patient can be seen faster and receive the same level of care by seeing an allied health professional. Why take up a GP’s valuable time to issue a sick note, when an occupational therapist could deal with this request? Why see a doctor about a cold when the pharmacist can provide you with the best treatment option? As I highlighted earlier, this will require a complete mindset change from the general public, which is why we have to help them make the right choices. Adverts will only get us so far. We have to introduce a system of triaging patients, and I believe that the 111 service has the potential to be that system. Make it a one-stop shop for the NHS and help ensure that patients get the best treatment at the right time by signposting them to the most appropriate service.
Our NHS can’t afford another bad winter leading to a bad spring and a worse summer. We have to act now and take the bold steps needed to relieve the pressures on the system. Diolch yn fawr.

I call the Cabinet Secretary for Health and Social Services, Vaughan Gething.

Vaughan Gething AC: Thank you, Llywydd. I'm grateful to the opposition for tabling today's debate. The overall sentiment—delivering high-quality services that meet high and increasing demand—is something on which I'm sure we can all agree, but obviously there are points of disagreement within the motion; hence a Welsh Government amendment.
The parliamentary review, made up of a panel of independent experts that every party in this place supported, described the increasing demands and new challenges that the NHS and social care face: an ageing population, lifestyle factors and changing public expectations. We know that, despite these demands, the vast majority of patients who need NHS services receive care in a timely manner, with high rates of satisfaction. The fact that typical NHS care is effective, timely and compassionate is, of course, thanks to our staff. But, in terms of capacity to meet the demand for services, there is now a record number of staff working within NHS Wales. It is the only public service, in an age of austerity, that has seen an increase in head count, and I will in the coming weeks announce my decision on investing in the future of our healthcare workforce.

Vaughan Gething AC: I have previously described how 'A Healthier Wales' sets out our commitment to enable health and social care services to meet population need—as I've said before, the first time we have ever had a joint health and social care plan with ownership between health, local government and the third sector. A transformation programme will bring pace and purpose to how we invest in people and how we build staff capacity, and we know that improving system capacity to plan effectively and efficiently is essential. We're delivering on a key priority to work with health and social care organisations and partners to simplify the planning and delivery of our services. Our amendment recognises the comprehensive work of our staff within the NHS, within local government, and wider partners, to plan and build capacity around and within NHS Wales to meet demand for services throughout the year. We, of course, heard some of this, in relation to specific planning for winter, in the earlier comments of David Melding.
We've been open about the challenges felt by out-of-hours primary care, critical care and emergency ambulance services, and we also know that, despite this pressure, the vast majority who require these services continue to receive timely access and high standards of care—once again, thanks to our compassionate and dedicated staff. As an example, the latest available figures show people categorised as 'immediately life threatened' in our red category of emergency ambulance calls receive a response in just over five minutes on average, and Dawn Bowden was right to point out that our model for emergency ambulance services is being copied in Scotland and England. We've been clear about how we're targeting national support for these services, with a clear understanding of demand and how best to manage it. That will help us to deliver sustainable out-of-hours primary care as well as critical care services. I've recently announced an additional £5 million to be made available this year for critical care, which will help us to create the capacity that is required over winter and tocreate a foundation for sustainable improvement.
We have commissioned an independent review of ambulance services and the amber category to understand whether improvements can be made to the management of patients and, of course, we'll have a statement on that next month and an opportunity for Members to consider that in advance. There is significant work under way in all three areas to focus on the need to recognise and understand pressures and plan to meet them. Our plan is to help support front-line staff to deliver those high-performing services, focusing on experience, outcome and value.
As to developing a national plan to address pressures on services, 'A Healthier Wales' describes our commitment to delivering a whole-system approach, where all services are delivered seamlessly and wrapped around the needs of the individual. It is imperative that we do not consider services in isolation. We shouldresist the regular calls in this place and in others to create new and piecemeal specific plans, but concentrate on delivering action that we have set out and agreed in our long-term plan.
On bed numbers—a point was made at various points in the debate—we actually have a lower occupancy rate than in England and more beds, proportionately, than the system in England. Now, specifically on critical care, I made reference to the £5 million this year to help support a permanent increase in the number of critical care beds, and that does underline our commitment to strengthening critical care and we recognise that that is necessary, not only for the winter, but in the longer term. That follows my recent announcement of £15 million of recurrent funding from the next financial year for these essential services.
On our emergency ambulance services, we already have a national plan. The Welsh ambulance service trust has an approved plan up to 2021, based on commissioning intentions that are set out by the chief ambulance commissioner. Members will, no doubt, be interested to know that the collaborative commissioning arrangements that we have in Wales have recently been copied in England. We know there are more paramedics working in Wales than ever before, and, since 2014, the number of paramedic training places has more than doubled—not by accident, but by deliberate choices made by Welsh Labour leadership.
On primary care out-of-hour services, there's been a significant and collective focus on this area over the past year. As part of our broader plan, work is under way to develop a new model of out-of-hours primary care, modelled on seamless integration with other services through the 111 service. And I'm pleased to hear both in this debate and in recent weeks recognition of the successful impact that the 111 service has had where it's been rolled out. I'd caution Members who would demand an immediate roll-out of that service across the country. Part of the success has been to understand the demand of each area and to build capacity in primary care support and to make sure that we have the right staff in the right place to deliver the quality of service.

Angela Burns AC: Will you take an intervention?

Vaughan Gething AC: I'll happily take an intervention.

Angela Burns AC: But surely you recognise that having somewhere like Aneurin Bevan health board having no out-of-hours cover for parts of the day on 27 different days simply isn't acceptable if we're trying to take this pressure away.

Vaughan Gething AC: And that's why we're committed to rolling out the 111 service. We are committed to improving out-of-hours care, just as every Government across the United Kingdom is. We're actually doing something about it. And you will see the 111 service arriving in Aneurin Bevan in the near-ish future.
Now, on staff numbers—[Interruption.] Well, on staff numbers, it's worth reflecting, as I said, that we've continued to invest during a time of Tory austerity, but it isn't just the numbers of staff; it's how they do their job. That's why integrating health and social care services with seamless models of care is a priority for the Welsh Government. Despite significant cuts to the Welsh Government's budget, after eight hard years of Tory austerity—which, Dawn Bowden reminds us, are continuing—we have continued to invest in social services. This is a significant difference to what is happening across the border, where Conservative choices—deliberate choices—have been made to cut and cut again social care in England. Yet, here in Wales, we have had £50 million this year in the integrated care fund, £100 million over two years into the transformation fund, and £30 million next year for regional partnership boards.
There is a radically different story being told here in Wales about our choices in a time of austerity and what is happening when the Conservatives are actually in power. And there is a contradiction in a number of the comments that have been made by Conservative speakers today—on the one hand calling for more money to go into primary care, but, on the other hand, calling for more money to go into secondary care. It simply isn't possible to do both of the things you are suggesting and, at the same time, demand you get more money to put even more money into local government. These are the unavoidable consequences of Tory austerity, and I should remind you of that undeniable fact. The Conservative Party has campaigned for austerity in three successive general elections. You cannot champion austerity at the ballot box and then run away from its undeniable, indivisible consequences. We will continue to prioritise social care as a sector of national importance. It is front and centre in 'A Healthier Wales', our joint plan for health and social care, designed and owned, for the first time, by health, local government and the third sector.
We know the NHS needs to transform to meet the needs and demands of today and the future, but one thing will remain as it always has: the NHS will continue to deliver to meet the needs of the people who need it most, and those people will never trust the Tories with our NHS.

I call on Suzy Davies to reply to the debate.

Suzy Davies AC: Diolch yn fawr, Llywydd. Yes, it's always easy, isn't it, to make yourself try and look better just because another Government might be doing worse than they used to. That does not disguise the fact that you are still producing the poorest health results across the UK. Can I thank everyone who took part in this debate, please? I'm sorry I'm not going to have time to respond to it all, because I don't have much time. But this debate was essentially about the difference between a vision, which a lot of us were behind, and that lived experience of our constituents—and, indeed, our doctors, judging from what Dai Lloyd said.
Angela Burns's example of the gentleman who was waiting five hours just to go a few hundred yards is not unique, but it is illustrative of the problems that we were trying to raise in this debate and hoping to get some sensible response from the Government on. Because, Cabinet Secretary, I'm sure you're not thrilled by those out-of-hours statistics either, or the delayed transfer of care statistics, how long ambulances are waiting outside hospitals—I'm not very happy with you pulling your statement on ambulance times, by the way—or, in fact, the fact that paramedics, 8.8 per cent of them, are off sick. [Interruption.] But all this is happening on your watch.
We're all behindyou with this parliamentary review direction, following the work that was done on that, towards improved community care—it was a policy direction we were all tending to follow anyway—but we are not feeling it, and that is why your amendment is so hollow. The references to social care we tend to hear here are still feeling like an afterthought compared to the health service. We have examples in my own constituency of temporary closures of services and clinics—temporary that become permanent, because staff get redeployed; that happened in Maesteg. We have new ideas, like the Red Cross's work with individuals who are making a series of inappropriate 999 calls, being trialled at Morriston. Fantastic results—money pulled. And of course, when you're talking about a social model of community care, it's not just about GPs; it's about people like the Red Cross and the paramedics and the pharmacists and the third sector.
So, I want you to look at community care, if you like, as a sort of preventative flood plain in which care and well-being of our constituents can be better managed. Flood plains don't just alleviate the effects of storm water further downstream; they create a fertile soil. It's where things grow, where things get better, where you get signs of health. If community care is about preventative care producing those valuable results less stressfully and more efficiently upstream, that's where the investment should be. But if you let these storm waters—and they're increasing; they're all-year-round now—just continue to surge across an arid desert, you're going to stay and remain with the results that we have now.
That 5 per cent cut that Angela Burns spoke about—I know you're talking about in-year increases, but that 5 per cent cut is fundamentally undermining the purposes of 'A Healthier Wales' here, and it doesn't do, as Caroline Jones actually mentioned—. If you're not investing in community care, you are not creating trust in a part of the health service where that trust needs to be created in order to persuade people to move away from the 999 buttons on their phone.
So, I don't particularly want to wait until next week, Cabinet Secretary. I'm sorry you didn't mention this in your response to this debate, but there is a transformation fund—two, in fact; you mentioned it earlier—and I don't see yet how they're contributing to creating the community care that we need to stop the problems from happening downstream.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I will defer voting until voting time.

Voting deferred until voting time.

Unless three Members wish for the bell to be rung, I will move immediately to voting time.

8. Voting Time

The first vote is on the Welsh Conservatives’ debate on NHS capacity and I call for a vote on the motion, tabled in the name of Darren Millar. Open the vote. Close the vote. In favour 15, one abstention and 34 against. Therefore, the motion is not agreed.

NDM6829 - Motion without amendment: For: 15, Against: 34, Abstain: 1
Motion has been rejectedClick to see vote results

On amendment 1, if amendment 1 is agreed, amendments 2 and 3 will be deselected. I call for a vote on amendment 1, tabled in the name of Julie James. Open the vote. Close the vote. In favour 30, one abstention and 19 against. Therefore, amendment 1 is agreed.

NDM6829 - Amendment 1: For: 30, Against: 19, Abstain: 1
Amendment has been agreedClick to see vote results

Amendments 2 and 3 deselected.

Amendments 2 and 3 are therefore deselected, which brings us to the motion as amended.

Motion NDM6829 as amended:
To propose that the National Assembly for Wales:
1. Recognises the work that is being done to build the capacity of the Welsh NHS to meet demand for services throughout the year, not just in the winter months.
2. Notes that year-round pressures need to be recognised and understood to support the ability of the NHS to provide consistent and equitable access to out-of-hours, critical care and ambulance services.
3. Calls upon the Welsh Government to support the implementation of a Healthier Wales to address pressures on out-of-hours, critical care and ambulance services to ensure that patients receive timely services which meet their needs.

Open the vote. Close the vote. In favour 28, one abstention and 21 against. The motion as amended is therefore agreed.

NDM6829 - Motion as amended: For: 28, Against: 21, Abstain: 1
Motion as amended has been agreedClick to see vote results

The Deputy Presiding Officer took the Chair.

9. Short Debate: Meeting our climate commitments—A 100 per cent renewable Wales

If you're leaving the Chamber, please do so quickly and quietly.
We now move to the short debate, and I call on Lee Waters to speak on the topic he has chosen. Lee.

Lee Waters AC: Thank you, Deputy Presiding Officer. I'm pleased to give a minute of my time to Jenny Rathbone.
The science is unequivocal: the link between human activity and rising global temperatures is as strong and as certain as the link between smoking and cancer, according to the American Association for the Advancement of Science. The Paris climate change agreement set a target of no more than 2 degrees centigrade global warming above pre-industrial temperatures by the end of the century. It also set an aspirational target of no more than 1.5 degrees centigrade. We're currently on track for more than 3 degrees centigrade global warming by the end of the century. We're likely to burnthrough the rest of the aspirational carbon budget within the next three to 10 years and reach 1.5 degrees of warming by 2040.

Lee Waters AC: Now, 1.5 degrees doesn't sound like much, but it translates to more frequent and more extreme weather events, such as storms, heatwaves and flooding—the kind of events that have a severe impact on human life. The difference between 1.5 degrees and 2 degrees of global warming is the difference between an Arctic that is free of ice once per decade, or once per century. It's the difference between the complete collapse of the world's coral reefs or the loss or around 30 per cent of this life-sustaining ecosystem.
To avert this potential catastrophe, the world must embark on a determined effort to transition away from fossil fuels as a source of energy. We can mobilise for war, we can recapitalise global banks with a massive programme of quantitative easing and so we can recalibrate to mitigate man-made climate change, if we chose to. The simple takeaway from this science is that the faster we cut carbon emissions, the less severe the impacts of rising global temperatures. Thankfully, much of the means of cutting our emissions already exist. We can act now. This means that a key priority for Wales must be transitioning our energy system to renewable sources. By energy, I mean the electricity we use to light our offices and power our televisions, as well as the energy we use to power our vehicles and heat our homes.
We must begin, like Germany and Denmark, by targeting a decrease in our energy demand, by increasing efficiency and eliminating waste. We can then start to decarbonise electricity. The Welsh Government's target is to produce 70 per cent of our electricity from renewables by 2030. We currently produce just 42 cent of our electricity from renewables and we need to move faster. We only have 12 years left to meet our target.
The technologies and means to do this already exist, and, as stark as the science might be, there are huge opportunities for Wales. We can be a leader in the development and deployment of wave and tidal renewables. There are firms in north Wales and south Wales developing industry-leading solutions to the key problems of at-sea renewable deployment. We need to ensure that we capitalise on our potential in this sector, quite unlike the story of wind energy, where Wales was once a world leader but fell behind and lost out on the valuable manufacturing and intellectual property that emerged.
But the most immediate opportunities still lie onshore, in wind and solar and even biomass—tried and tested technologies that are easy to build and maintain and, therefore, relatively low cost. We are close to a point where onshore renewables can operate without a subsidy, ending concerns that green energy will artificially inflate household bills. The cost for new renewables is now significantly below that of nuclear, and competitive with new gas power stations. This is game changing.
One of the UK’s most significant and underutilised wind resources is in rural Wales, but there is only opportunity to build out a small number of projects due to a constrained grid. The lack of grid capacity restricts other opportunities too. At the moment, most of rural Wales will not be able to put in place significant electric vehicle charging, renewable heating or even build new employment because we can’t transport enough electricity, and we risk isolating the people of rural Wales, and part of my own constituency, from changing technology and new opportunities.
It’s reported that storage of more than 1 MW capacity can’t be installed in Wales until the latter half of the next decade. This capacity is needed to support high generation and use of renewables. And until we sort this, I don’t see how we’ll be able to meet our target of producing 70 per cent of electricity from renewables by 2030. And more to the point, if we can’t accelerate this timetable, it might be too late to prevent catastrophic global warming. The new National Infrastructure Commission for Wales should consider the grid as a priority as should thenational development framework being developed by the Welsh Government. To unlock funding to build this grid, could the public sector, through pension funds and other investments, invest in the grid? Instead of maxing out our borrowing capacity on building a mega-road that will lock in further emissions increases and build through protected wetlands, which are after all a carbon sink, we should prioritise projects that help us meet our commitments to future generations, not blow them out of the water. And it could help us here and now. Enabling renewable energy generation will create a stable, long-term economic return for the people of Wales.
So, we must withdraw funding from dirty energy. Welsh local government pension funds currently have over £1 billion invested in fossil fuels, money that could be put to far better use supporting a new green economy in Wales. New research by the Institute of Welsh Affairs suggests that we could create 3,500 jobs just in the Swansea bay city region, which includes the Llanelli constituency, by switching to a 100 per cent renewable electricity network, and most of this work would be long-term roles in operation and maintenance.
The IWA has been carrying out extensive research into what practical steps would be needed to turn Wales into a country that meets all its energy needs from renewable sources. That's the kind of bold response we need to see to the warning of the Paris agreement. It's all very well us passing symbolic legislation and being showcased at the UN; it's action that counts—action for the long term that produces tangible benefits in the short term too.
The IWA research suggests that the economic benefits of refitting housing to a higher energy efficiency standard is around £1.6 billion over a 15-year period. Because the firms that would carry out this work are locally rooted in the foundational economy, these benefits are likely to be retained in and by our communities. We already have world leading expertise in sustainable building in our universities, in our housing associations and in our private sector, and we should use this to ensure that all new builds in Wales meet stringent standards for carbon emissions. So, I'm pleased that the Minister for housing has announced funding of £4 million for an innovative green housing project in Burry Port in my constituency.
Of course, this isn't just about electricity and heat; it's also about transport. We must decarbonise our transport system. The more immediate and effective solution is to break the dependency on private transport, moving people to public transport and active travel for short journeys. Getting more people walking and cycling have all sorts of wider benefits to the health and well-being of the nation too. It's the solution that makes sense at all sorts of levels.
As significant and important an innovation as electric vehicles are, they aren't the answer to this problem without a transformed electricity system. All that said, Welsh Government should set out an ambition to end the sale of new petrol and diesel vehicles in the UK. The UK Government has announced a ban by 2040, with other European countries going much earlier. Let's set our aspiration higher and let's leverage the auto sector we have based in Wales to turn this into an opportunity. Welsh Government is working on a new Welsh transport strategy, and it must surely place at its heart the need to decarbonise the transport sector, not just in the words at the front but in the actions at the back. And there is a need to ensure that the energy we do use for transport comes from renewable sources, be that electricity, hydrogen or biofuels.
Wales can use this climate crisis as an opportunity to become a world leader, not just in words but in the deployment of renewable technologies and decarbonisation of the energy system. The timescale is pressing and we need to act, but there are opportunities to improve the lives of Welsh citizens as we do it. Diolch.

Jenny Rathbone AC: We have lots of warm words on this, and the Cabinet Secretary has set a challenging 70 per cent target for generating renewable energy for Wales. But we now need to transfer words into action, not least for future generations. Up to now, the planning system has been used to undermine the enthusiasm of citizens who want to do the right things, and most have succumbed under the welter of problems that have been put in their way. Yesterday, we had an encouraging list of innovative housing awards across Wales, which will deliverzero-carbon affordable homes for some 600 households. We need to do more and better. We need to change the planning rules, the building regulations, to ensure that future homes all meet these challenging zero-carbon emissions, which is what Gordon Brown endeavoured to introduce back in 2007 but was torn up by the UK Government in 2015. I recently attended a meeting with Welsh Water, who informed us there was nothing they could do to capture grey water for reuse until the building regulations change to ensure that grey water is separated when it comes off the roof and the roads, so that it doesn't just go into the sea. So, I would urge the Cabinet Secretary to give us a timescale of when we can amend the building regulations to meet the ambitions that we need to deliver on for the sake of our grandchildren.

Can I now call the Cabinet Secretary for Energy, Planning and Rural Affairs to reply to the debate? Lesley Griffiths.

Lesley Griffiths AC: Thank you, Deputy Presiding Officer, and thank you, Lee, for bringing forward this short debate today. I'd also like to welcome the work of the Institute of Welsh Affairs' Re-energising Wales project. The work considers how we could meet 100 per cent of our energy demand from renewables by 2035, and the benefits this could offer for Wales. I await the outcomes of their research with interest.
Last year I set an ambitious target of generating 70 per cent of Wales's energy consumption from renewable sources. Achieving 100 per cent renewable generation would be very challenging and could leave us relying on our neighbours to keep the lights on in Wales.
Last week, the Intergovernmental Panel on Climate Change released a very hard-hitting report on the impacts of global warming. This highlighted how limiting warming to 1.5 degrees rather than 2 degrees would offer multiple benefits for food and water supplies, human health and the environment. To limit global warming to 1.5 degrees, the IPCC recommend we need to scale up renewable generation rapidly to provide around 85 per cent of the world's electricity by 2050. This would be supported by nuclear and fossil fuels with carbon capture and storage. IPCC state gas is likely to generate around 80 per cent of electricity worldwide to provide flexibility and security. Limiting emissions would require carbon capture and storage, and this technology is as yet unproven.
In its national infrastructure assessment, the UK National Infrastructure Commission recommended the energy system should be running off at least 50 per cent renewable generation by 2030, as part of a transition to a highly renewable generation mix. The commission's modelling showed delivering a low-carbon electricity system for 2050, powered mainly by renewables, is a low-cost option.
In Wales, we are already acting on climate change through the Environment (Wales) Act 2016, where we have legislated to reduce emissions by at least 80 per cent by 2050. I will be asking the Assembly to approve our interim emissions targets to 2050 and our first two carbon budgets later this year. Our focus is now on the actions we need to take to deliver against our targets. We are developing our evidence base to inform the development of our first low-carbon delivery plan, which will be published in March next year.
I've raised concerns with the UK Government about their decision to exclude onshore wind and solar technologies from contracts for difference, the proposed closure of the feed-in tariff, and the lack of funding to support wave and tidal technologies. These support mechanisms have driven the mass uptake of renewable generation and enabled dramatic cost reductions. We need the UK Government to review the current subsidy regime so it reflects the importance of onshore wind and solar to an affordable energy mix.
In Wales, we're working to promote and enable renewable energy and this work is taking effect. Renewables generated enough electricity to meet 43 per cent of consumption in Wales in 2016, and indications are this has risen further to 48 per cent in 2017. This summer, the Minister for Environment attended the inauguration of the BrechfaForest West windfarm and launched the £460,000 annual community investment fund. The Welsh Government woodland estate also hosts Pen y Cymoedd, which is the largest onshore wind project in England and Wales. In addition to the work the Crown estate, with whom I met this morning, is undertaking for potential new leasing, it has also identified potential for an extension to the existing Gwynt y Môr offshore windfarm.
Renewable energy generation on its own, however, does nothing to decrease our carbon emissions. We must remove fossil fuel generation in order to decarbonise. Currently, Wales hosts 19 per cent of the UK's gas-fired electricity generation capacity. However, we use less than 6 per cent of the UK's total electricity. Eighty-two per cent of the electricity generated in Wales last year was from coal and gas. We are considering how much gas generation Wales should host in the future and the levers we have available to manage this. Decisions on future nuclear plants will be taken at a UK Government level. Wylfa Newydd will provide valuable low-carbon base-load energy for the UK system. However, if Wales is to host such strategic energy projects, they must provide wider economic, social and environmental benefits to Wales.
Moving towards clean energy also requires action to move away from fossil fuel extraction. I'm committed to taking action to prevent Wales being locked into further fossil fuel extraction through onshore unconventional oil and gas, such as shale or coal-bed methane.
By the end of this year, I will be launching a comprehensive update of 'Planning Policy Wales'. In response to Jenny Rathbone's question, I'll be doing PPW's revised edition before the end of this term. As you know, we are looking at a review of building regulations that will go into early next year. As part of the revision of PPW, I will strengthen planning policy in relation to the extraction of onshore unconventional oil and gas. PPWwill be a key part of our stronger national policy to promote renewable energy. I want local planning authorities to see renewable resources as valuable assets. We've introduced new requirements for local authoritiesto identify areas for new wind and solar generation and to set local targets for renewable energy in their plans.
The national development framework and the national marine plan for Wales provide us with an opportunity to consider the infrastructurewe need to deliver a decarbonsied economy. For the NDF, we are working to identify onshore wind and solar resources in Wales, the impacts of harnessing them, and the most appropriate areas for generation to be encouraged. Similarly, for the marine plan, policies will be developed to harness sustainable marine renewable energy. However, given the electricity that Wales already exports, new generation must deliver sufficient benefit to justify Wales hosting it.
Research undertaken by the Centrefor Low Carbon Futures, across a range of global city regions, shows significant export of economic value simply by paying energy bills. In the UK regions studied, this was between 5.9 per cent and 18 per cent of gross value added being exported. Locally owned generation provides a strong opportunity to retain money in the local economy, contributing to prosperity. This is why I set a target for 1 GW of locally owned electricity generation by2030 and an expectation for all new developments to have an element of local ownership from 2020. Our policy position on renewable energy must deliver the purpose of retaining benefit locally whilst not acting as a barrier to new generation. Our call for evidence on local ownership closed in the spring and I will publish our response next month.
We will be supporting regional energy planning through the energy atlas. This will be a tool to help local authoritiesand others realise the central role of decarbonisation in planning for the future of their areas. Regional energy planning will need to encompass electricity, heat and future developments, such as increasing demand for power from electric vehicles. The roll-out of electric vehicles requires infrastructure, as Lee Waters referred to, and we are working with the National Grid and two distribution network operators in Wales to support their work to understand the impacts of expanding the charging infrastructure in Wales.
We also need to understand more about how a smart and interconnected energy system will work in practice. We are fortunate in Wales having SPECIFIC and FLEXIS—EU-funded initiatives that have brought together expertise from our universities to inform innovative developments in energy positive buildings and smart living. We are complementing this with our work on the smart living demonstrators.
I've proposed a debate, Deputy Presiding Officer, for 20 November, during which I would like us to explore what role Wales should play in the UK and global energy marketplace. It would be helpful to explore the levels of generation Members think we should be looking for. This is important as we will need collectively to exhibit strong leadership to deliver these changes and secure maximum benefits for the people of Wales. Diolch.

Thank you very much. That brings today's proceedings to a close. Thank you.

The meeting ended at 18:24.

QNR

Questions to the Cabinet Secretary for Education

Angela Burns: Will the Cabinet Secretary outline what support is in place to aid school governors in their roles?

Kirsty Williams: The Welsh Government is supporting governors through our own guidance and support from the regional consortia and local authorities. We will look to the review of the national model for regional working and the National Academy for Educational Leadership to identify how to continue to improve that support.

Mohammad Asghar: What action is the Welsh Government taking to improve working conditions for teachers?

Kirsty Williams: I have recently received an independent report from Professor Mick Waters, setting out a comprehensive set of recommendations to improve the working conditions of teachers. I am currently considering these proposals in detail and will make a further statement in due course.

Mark Isherwood: What is the Welsh Government's policy on the provision of education for pupils educated other than at school?

Kirsty Williams: I expect all learners to have access to suitable, high-quality education that allows them to achieve their potential. For this reason, in December 2017, I published the EOTAS framework for action, our long-term plan to improve outcomes and raise standards in EOTAS provision.

David J. Rowlands: What assessment has the Cabinet Secretary made of educational standards in Wales?

Kirsty Williams: Educational standards in Wales have improved significantly over the last decade. 'Our national mission' will focus on raising school standards, reducing the attainment gap and delivering an education system that is a source of national pride and public confidence.

Andrew R.T. Davies: Will the Cabinet Secretary make a statement on the Welsh Government's funding for education across South Wales Central?

Kirsty Williams: Welsh Government support for authorities in South Wales Central, as for all authorities in Wales is provided mainly on a non-hypothecated basis through the local government settlement—revenue support grant. The Welsh Government also provides hypothecated grants for a wide range of education policies.

Questions to the Minister for Lifelong Learning and Welsh Language

Mark Isherwood: How is the Welsh Government supporting adult learning?

Alun Davies: Our consultation on the delivery and funding structure of adult learning in Wales closed on 11 September. My officials are currently in the process of analysing the responses with a view to publishing a summary within 12 weeks of the closing date, in line with our stated policy.

Neil Hamilton: Will the Cabinet Secretary make a statement on the provision of adult education?

Alun Davies: Our consultation on the delivery and funding structure of adult learning in Wales closed on 11 September. My officials are currently in the process of analysing the responses with a view to publishing a summary within 12 weeks of the closing date, in line with our stated policy.

Questions to the Cabinet Secretary for Health and Social Services

Dai Lloyd: Will the Cabinet Secretary make a statement on the performance of Abertawe Bro Morgannwg University Health Board?

Vaughan Gething: The health board’s performance is now improving in a number of areas. The number of people currently waiting over 36 weeks is 23 per cent lower than last year and we expect to see further improvements in future months. Progress has also been made on diagnostic, therapy and cancer waits.

Janet Finch-Saunders: Will the Cabinet Secretary make a statement on waiting times for knee and hip replacements in north Wales?

Vaughan Gething: I have made it clear to the health board that I expect to see improvements in all waiting times, including for knee and hip replacements. My officials continue to work alongside the health board as they develop their orthopaedic plan.

Dawn Bowden: Will the Cabinet Secretary make a statement on services available for women going through the menopause?

Vaughan Gething: We take women’s health, including menopausal concerns, very seriously and expect all health boards to provide a full range of services to women experiencing the menopause in accordance with National Institute for Health and Care Excellenceguidance.

Mandy Jones: What action is the health service in North Wales taking in preparation for winter?

Vaughan Gething: Officials have received the health board’s integrated winter delivery plan and provided feedback to inform further enhancement of its plan. Officials will continue to work alongside the health board to help it understand the demand and capacity required to meet the needs of its population and identify opportunities for national and local support, as required.

Jenny Rathbone: Will the Cabinet Secretary make a statement on women’s access to NHS abortion services in Cardiff?

Vaughan Gething: The Welsh Government expects all health boards to provide safe, timely, high-quality termination of pregnancy services for women living in their areas.

Mohammad Asghar: What plans does the Cabinet Secretary have to review the complaints procedure in the National Health Service?

Vaughan Gething: The 'Putting Things Right' complaints procedure was independently reviewed by Keith Evans in 2014. He concluded the process had a good overall approach but made recommendations for further improvements. The vast majority of these have been implemented and benefits felt by patients. There are no plans for a further review.

David J. Rowlands: Will the Cabinet Secretary confirm the opening date for the critical care centre in South Wales East?

Vaughan Gething: Construction on the Grange hospital site commenced on 30 October 2017 and it is due to open in the spring of 2021.